Inhomogeneity of cellular activation time and Vmax in normal myocardial tissue under electrical field stimulation.

To clarify the mechanism underlying the ectopic excitation after countershock, the cellular activation processes of cardiac tissue with a low-potential-gradient electric field (LPEF) were investigated in experiments using guinea pig papillary muscles and in computer simulation. Action potential upstrokes in papillary muscles during longitudinal propagation (LP) or transverse propagation (TP) were different from those of nonpropagating ones in single ventricular cells in terms of lower maximum upstroke velocity (Vmax) (LP, 231 V/s; TP, 309 V/s) and the presence of a linear ascending segment in the phase-plane plot. High Vmax (409 V/s) close to the single cell (512 V/s) was obtained in the muscle at the collision of LP (LC). Field stimulation of the muscles with LPEF < 5 V/cm caused inhomogeneous excitation suggesting multiple wave fronts, which collide with each other, and a wide spatial dispersion of Vmax (132-388 V/s). Phase-plane plots of action potential with lower Vmax were similar to LP or TP, whereas those with higher Vmax were similar to LC. In the two-dimensional discrete sheet composed of 51 x 51 elements of modified Beeler-Reuter model, the inhomogeneous excitation induced by LPEF is mimicked by setting a random variation of stimulus onset in each element. LPEF may induce inhomogeneous excitation with multiple wave fronts through a complex electrotonic interaction. This would provide a basis for the genesis of ectopic focal excitation.