A governing equation for rotor and wavelet number in human clinical ventricular fibrillation: implications for sudden cardiac death

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dc.contributor.authorDharmaprani, D.
dc.contributor.authorJenkins, E.V.
dc.contributor.authorQuah, J.X.
dc.contributor.authorLahiri, A.
dc.contributor.authorTiver, K.
dc.contributor.authorMitchell, L.
dc.contributor.authorBradley, C.P.
dc.contributor.authorHayward, M.
dc.contributor.authorPaterson, D.J.
dc.contributor.authorTaggart, P.
dc.contributor.authorClayton, R.H.
dc.contributor.authorNash, M.P.
dc.contributor.authorGanesan, A.N.
dc.date.issued2021
dc.descriptionAvailable online 15 October 2021
dc.description.abstractBACKGROUND: Ventricular fibrillation (VF) is characterised by multiple wavelets and rotors. No equation to predict the number of rotors and wavelets observed during fibrillation has been validated in human VF. OBJECTIVE: We hypothesized a single equation derived from a Markov M/M/∞ birth-death process, could predict the number of rotors and wavelets occurring in human clinical VF. METHODS: Epicardial induced VF (256-electrodes) recordings obtained from patients undergoing cardiac surgery were studied (n=12 patients, n=62 epochs). Rate constants for phase singularity (PS, which occur at the pivot points of rotors) and wavefront (WF) formation and destruction were derived by fitting distributions to PS and WF inter-formation and lifetimes. These rate-constants were combined in an M/M/∞ governing equation to predict the number of PS and WF in VF episodes. Observed distributions were compared to those predicted by the M/M/∞ equation. RESULTS: The M/M/∞ equation accurately predicted average PS and WF number and population distribution, demonstrated in all epochs. Self-terminating episodes of VF were distinguished from VF episodes requiring termination by a trend towards slower PS destruction, and slower rates of PS formation, and a slower mixing rate of the VF process, indicated by larger values of the second-largest eigenvalue modulus (SLEM) of the M/M/∞ birth-death matrix. The longest-lasting PS (associated with rotors) had shorter inter-activation time intervals compared to shorter lasting PS lasting <150 ms (∼1 PS rotation in human VF). CONCLUSIONS: The M/M/∞ equation explains the number of wavelets and rotors observed, supporting a paradigm of VF based on statistical fibrillatory dynamics.
dc.description.statementofresponsibilityDhani Dharmaprani, Evan V.Jenkins, Jing X.Quah, Anandaroop Lahiri, Kathryn Tiver, Lewis Mitchell ... et al.
dc.identifier.citationHeart Rhythm, 2021; 19(2):295-305
dc.identifier.doi10.1016/j.hrthm.2021.10.008
dc.identifier.issn1547-5271
dc.identifier.issn1556-3871
dc.identifier.orcidDharmaprani, D. [0000-0003-4660-0119]
dc.identifier.orcidMitchell, L. [0000-0001-8191-1997]
dc.identifier.urihttps://hdl.handle.net/2440/133345
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1063754
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/101188
dc.rights© 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.hrthm.2021.10.008
dc.subjectVentricular fibrillation
dc.subjectmechanisms
dc.subjectphase singularities
dc.subjectrenewal process
dc.subjectrotors
dc.subjectwavelets
dc.titleA governing equation for rotor and wavelet number in human clinical ventricular fibrillation: implications for sudden cardiac death
dc.typeJournal article
pubs.publication-statusPublished

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