The behavior of the 2006 ten Tusscher-Panfilov model of human ventricular myocytes under the impact of periodic excitation impulses was studied in the BeatBox simulation environment. The cardiomyocyte model has a limited susceptibility to an forced higher frequency excitation rhythm. A high-frequency excitation rhythm can be forced by gradually increasing the frequency of excitation impulses. The mechanism of defibrillation pulse impact consists of presumably prolonging the refractoriness of cardiomyocytes which undermines their susceptibility for a long time to a forced high-frequency rhythm of fibrillation, as a result for which they hinder the propagation of a fibrillation wave. This is the only mechanism of defibrillation that was identified during the simulation. The threshold energy of a depolarizing defibrillation pulse prolonging the refractoriness of the cardio-myocyte varies depending on a delay relative to the excitation impulse (the excitation cycle phase) in a wide range (the maximum value exceeds the minimum by several thousand times). The results show differences in the mechanisms of impact on a cardiomyocyte between an excitation impulse and a monophasic defibrillation pulse.
References
[1]
Kroll, M.W. (1993) A Minimal Model of the Monophasic Defibrillation Pulse. Pacing and Clinical Electrophysiology, 16, 769-777. https://doi.org/10.1111/j.1540-8159.1993.tb01657.x
[2]
Walcott, J.P., Walker, R.G., Cates, A.W., Krassowska, W., Smith, W.M. and Ideker, R.E. (1995) Choosing the Optimal Monophasic and Biphasic Waveforms for Ventricular Defibrillation. Journal of Cardiovascular Electrophysiology, 6, 737-750. https://doi.org/10.1111/j.1540-8167.1995.tb00450.x
[3]
Fishler, M.G. (2000) Theoretical Predictions of the Optimal Monophasic and Biphasic Defibrillation Wave-shapes. IEEE Transactions on Biomedical Engineering, 47, 59-67. https://doi.org/10.1109/10.817620
[4]
Krasteva, V., Cansell, A. and Daskalov, I. (2000) Modelling Transthoracic Defibrillation Waveforms. Journal of Medical Engineering & Technology, 24, 63-67. https://doi.org/10.1080/030919000409320
[5]
Gorbunov, B.B. (2009) Characteristic Energy Method for Evaluation of Monopolar Defibrillation Pulse Efficiency. Biomedical Engineering, 43, 56-61. https://doi.org/10.1007/s10527-009-9097-5
[6]
Vostrikov, V.A., Gorbunov, B.B., Gusev, A.N., Nesterenko, I.V. and Selishchev S.V. (2013) Determination of Threshold Energy Level of Monopolar Defibrillation Pulses Using the Luo-Rudy Cardiomyocyte Model. Biomedical Engineering, 47, 61-64. https://doi.org/10.1007/s10527-013-9335-8
[7]
Vostrikov, V.A., Gorbunov, B.B., Gusev, A.N. (2014) Computer Simulation of Cardiomyocyte Membrane Exposure to First-Phase Bipolar Defibrillation Impulses. General Reanimatology, 10, 29-32. https://doi.org/10.15360/1813-9779-2014-1-25-32
[8]
Vostrikov, V.A., Gorbunov, B.B. and Selishchev, S.V. (2015) Construction of Energy-Optimal Smooth Monophasic Defibrillation Pulse Waveforms Using Cardiomyocyte Membrane Model. Journal of Biomedical Science and Engineering, 8, 625-631. https://doi.org/10.4236/jbise.2015.89058
[9]
Antonioletti, M., Biktashev, V.N., Jackson, A., Kharche, S.R., Stary, T. and Biktasheva, I.V. (2017) BeatBox – HPC Simulation Environment for Biophysically and Anatomically Realistic Cardiac Electrophysiology. PLoS One, 12, e0172292. https://doi.org/10.1371/journal.pone.0172292
[10]
ten Tusscher, K.H.W.J. and Panflov, A.V. (2006) Alternans and Spiral Breakup in a Human Ventricular Tissue Model. American Journal of Physiology—Heart and Circulator, 291, H1088-H1100. https://doi.org/10.1152/ajpheart.00109.2006
[11]
Gorbunov, B.B. (2017) Study the Impact of the Current Rectangular Pulses at a ten Tusscher-Panfilov Model of Human Ventricular Myocyte. https://www.researchgate.net/project/Study-the-Impact-of-the-Current-Rectangular-Pulses-at-a-ten-Tusscher-Panfilov-Model-of-Human-Ventricular-Myocyte
[12]
Swartz, J.F., Jones, J.L., Jones, R.E. and Fletcher, R. (1991) Conditioning Prepulse of Biphasic Defibrillator Waveforms Enhances Refractoriness to Fibrillation Wavefronts. Circulation Research, 68, 438-449. https://doi.org/10.1161/01.RES.68.2.438
[13]
Li, H.G., Jones, D.L., Yee, R. and Klein, G.J. (1995) High Voltage Shock Induced Cellular Electrophysiological Effects: Transient Refractoriness and Bimodal Changes in Action Potential Duration. Pacing and Clinical Electrophysiology, 18, 1225-1235. https://doi.org/10.1111/j.1540-8159.1995.tb06962.x
[14]
Gorbunov, B.B. (2012) A Study of the Myocardium Cell Membrane Using the Luo-Rudy Model. Biomedical Engineering, 46, 117-119. https://doi.org/10.1007/s10527-012-9282-9
[15]
Cansell, A. (1998) Wirksamkeit und Sicherheit der Impulskurvenformen bei transthorakaler Defibrillation. Notfall & Rettungsmedizin, 1, 372-380. https://doi.org/10.1007/s100490050087
[16]
Janardhan, A.H., Li, W., Fedorov, V.V., Yeung, M., Wallendorf, M.J., Schuessler, R.B. and Efimov, I.R. (2012) A novel Low-Energy Electrotherapy That Terminates Ventricular Tach-ycardia with Lower Energy than a Biphasic Shock When Antitachycardia Pacing Fails. Journal of the American College of Cardiology, 60, 2393-2398. https://doi.org/10.1016/j.jacc.2012.08.1001
