Keldermann R H, ten Tusscher K H W J, Nash M P, Bradley C P, Hren R, Taggart P, Panfilov A V
Department of Theoretical Biology, Utrecht University, Utrecht, The Netherlands.
Am J Physiol Heart Circ Physiol. 2009 Feb;296(2):H370-9. doi: 10.1152/ajpheart.00952.2008. Epub 2008 Dec 5.
Sudden cardiac death is one of the major causes of death in the industrialized world. It is most often caused by a cardiac arrhythmia called ventricular fibrillation (VF). Despite its large social and economical impact, the mechanisms for VF in the human heart yet remain to be identified. Two of the most frequently discussed mechanisms observed in experiments with animal hearts are the multiple wavelet and mother rotor hypotheses. Most recordings of VF in animal hearts are consistent with the multiple wavelet mechanism. However, in animal hearts, mother rotor fibrillation has also been observed. For both multiple wavelet and mother rotor VF, cardiac heterogeneity plays an important role. Clinical data of action potential restitution measured from the surface of human hearts have been recently published. These in vivo data show a substantial degree of spatial heterogeneity. Using these clinical restitution data, we studied the dynamics of VF in the human heart using a heterogeneous computational model of human ventricles. We hypothesized that this observed heterogeneity can serve as a substrate for mother rotor fibrillation. We found that, based on these data, mother rotor VF can occur in the human heart and that ablation of the mother rotor terminates VF. Furthermore, we found that both mother rotor and multiple wavelet VF can occur in the same heart depending on the initial conditions at the onset of VF. We studied the organization of these two types of VF in terms of filament numbers, excitation periods, and frequency domains. We conclude that mother rotor fibrillation is a possible mechanism in the human heart.
心脏性猝死是工业化国家主要的死亡原因之一。它最常见的病因是一种名为心室颤动（VF）的心律失常。尽管其具有巨大的社会和经济影响，但人类心脏中VF的机制仍有待确定。在动物心脏实验中最常讨论的两种机制是多子波和母转子假说。动物心脏中大多数VF记录与多子波机制一致。然而，在动物心脏中也观察到了母转子颤动。对于多子波和母转子VF，心脏的异质性都起着重要作用。最近公布了从人类心脏表面测量的动作电位恢复的临床数据。这些体内数据显示出相当程度的空间异质性。利用这些临床恢复数据，我们使用人类心室的异质性计算模型研究了人类心脏中VF的动力学。我们假设这种观察到的异质性可以作为母转子颤动的基础。我们发现，基于这些数据，母转子VF可在人类心脏中发生，并且消融母转子可终止VF。此外，我们发现根据VF发作时的初始条件，母转子和多子波VF可在同一心脏中发生。我们从细丝数量、兴奋周期和频域方面研究了这两种类型VF的组织情况。我们得出结论，母转子颤动是人类心脏中一种可能的机制。
