Termination of Reentrant Propagation By a Single Stimulus: A Model Study

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Abstract
A computer model of a ring-shaped one-dimensional cardiac fiber was used to examine responses of reentrant propagation to premature stimuli applied under different degrees of head-tail interaction. Two different types (type I and type II) of termination window (TW) were identified. The type I TW was generated by functional inhomogeneity created by reentrant propagation. The width of the type I TW was proportional to the degree of cellular uncoupling. In contrast, uniform reduction in sodium channel conductance decreased the width of type I TW. The type II TW was generated by electrical alternans created by the head-tail interaction of the reentrant action potential. It was demonstrated that electrical alternans were most significant in medium degree head-tail interaction. For stronger or weaker head-tail interaction, the electrical alternans tended to decrease. The type II TW was located in excitable gaps following reentrant action potentials of short duration. Its size was proportional to the degree of electrical alternans. The type II TW was usually much larger than the type I TW. A premature conditioning stimulus induced alternans and created a type II TW. This response implies that a conditioning stimulus could facilitate greatly the termination of clinical reentrant arrhythmias by programmed electrical stimulation.