Delayed activation and retrograde propagation in cardiac muscle: implication of virtual electrode effects.

Point cathodal stimulation of cardiac tissue was shown previously to produce both a dog-bone shaped virtual cathode transverse to the muscle fibers and two longitudinal virtual anodes. We hypothesize that virtual anodes can cause a region of delayed activation, separating two regions of early activation caused by the virtual cathode. Using a high-density electrode array in 42 superfused epicardial slices from 14 canine left ventricles, we observed regions of early and delayed activation and different pathways of retrograde propagation corresponding to the earlier patterns. Retrograde propagation was seen from the transversely located early activation area through areas of delayed activation toward the cathode, and from the early activation area toward the cathode directly. These pathways caused a wide dispersion in the direction of retrograde propagation (2 degrees +/- 31 degrees, n = 179, relative to the fast axis of threshold activation; radial velocity: 0.5 +/- 0.2 m/s, n = 95, in 12 slices from 8 hearts with stimuli of 330 micros, 0.8-30 mA). Delayed activations were observed 0 degrees +/- 6 degrees (n = 32) from the axis in 23 maps (at differing stimulation strengths) recorded in 13 slices from 10 hearts. We conclude that point cathodal stimulation induce delayed activation along the fiber axis and retrograde propagation both along and transverse to the axis.