Stochastic termination of spiral wave dynamics in cardiac tissue
- PMID: 36187938
- PMCID: PMC9524168
- DOI: 10.3389/fnetp.2022.809532
Stochastic termination of spiral wave dynamics in cardiac tissue
Abstract
Rotating spiral waves are self-organized features in spatially extended excitable media and may play an important role in cardiac arrhythmias including atrial fibrillation (AF). In homogeneous media, spiral wave dynamics are perpetuated through spiral wave breakup, leading to the continuous birth and death of spiral waves, but have a finite probability of termination. In non-homogeneous media, however, heterogeneities can act as anchoring sources that result in sustained spiral wave activity. It is thus unclear how and if AF may terminate following the removal of putative spiral wave sources in patients. Here, we address this question using computer simulations in which a stable spiral wave is trapped by an heterogeneity and is surrounded by spiral wave breakup. We show that, following ablation of spatial heterogeneity to render that region of the medium unexcitable, termination of spiral wave dynamics is stochastic and Poisson-distributed. Furthermore, we show that the dynamics can be accurately described by a master equation using birth and death rates. To validate these predictions in vivo, we mapped spiral wave activity in patients with AF and targeted the locations of spiral wave sources using radiofrequency ablation. Targeted ablation was indeed able to terminate AF, but only after a variable delay of up to several minutes. Furthermore, and consistent with numerical simulations, termination was not accompanied by gradual temporal or spatial organization. Our results suggest that spiral wave sources and tissue heterogeneities play a critical role in the maintenance of AF and that the removal of sources results in spiral wave dynamics with a finite termination time, which could have important clinical implications.
Conflict of interest statement
SN: Co-author of IP owned by Stanford University and University of California Regents. Honoraria from Abbott, Inc. Consulting fees from the American College of Cardiology Foundation, Beyond Limits.ai and TDK, Inc. royalty income from UpToDate. DK: Consulting fees from Insilicomed and research grants from AHA and NIH. Institutional fellowship support from Medtronic, St. Jude Medical, Biosense Webster, Boston Scientific and Biotronik. AD: Speaking honoraria from Medtronic. TB: Consulting fees/honoraria from Medtronic and Biotronik. VS: Consulting fees/honoraria from Biosense Webster and research grants from Biosense Webster, Medtronic, Boston Scientific, St. Jude Medical and Biotronik. JM: Consulting fees/honoraria from Topera, Stereotaxis, Biosense Webster, Biotronik and Medtronic. W-JR: Co-author of IP owned by the University of California Regents.
The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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