Supernormal excitability as a mechanism of chaotic dynamics of activation in cardiac Purkinje fibers.

Supernormality, which can be defined as greater than normal excitability during or immediately after action potential repolarization, has been observed in a variety of cardiac preparations. However, as yet, no description of the dynamics of tissue response to repetitive stimulation in the presence of supernormal or relatively supernormal excitability has appeared. Isolated sheep cardiac Purkinje fibers (2-5 mm in length) were superfused with Tyrode's solution and stimulated with depolarizing current pulses through a suction pipette. Recovery of excitability, restitution of the action potential duration, and response patterns were measured in each fiber for a wide range of current amplitudes and stimulation frequencies. When the potassium chloride concentration of the Tyrode's solution was decreased from 7 to 4 mM, the excitability recovery function consistently changed from monophasic ("normal") to triphasic ("supernormal'). During repetitive stimulation at increasing rates, normal preparations responded only with gradual changes in the activation ratio, expressed as periodic phase-locked responses (i.e., Wenckebach-like patterns, etc.). Supernormal preparations showed a nonmonotonic change in the activation ratio, as well as complex aperiodic response patterns. Numerical results from an analytical model gave a quantitative basis for the relation between nonmonotonicity in the excitability function and the development of complex rhythms in cardiac Purkinje fibers. Both our experimental and theoretical results indicate that the presence of supernormality and the slope of the action potential duration restitution curve at short diastolic intervals are responsible for the development of chaotic dynamics. Moreover, our results give an accurate description of the supernormality phenomenon, predict the behavior expected under such conditions, and provide insight about the role of membrane recovery in determining regular and irregular frequency-dependent rhythm and conduction disturbances.