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The Role of Microscopic Tissue Structure in Defibrillation

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Cardiac Bioelectric Therapy

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Abstract

Extracellular field shocks are applied between two extracellular electrodes placed on the body’s surface to convert ventricular fibrillation to sino-atrial rhythm. The basic question about the underlying mechanism relates to how electrical current flowing primarily through the extracellular space will flow across the cell membranes and affect the transmembrane potential of underlying cells. Experimental studies in whole hearts and cell cultures have shown that myocytes within the heart – at sites forming so-called virtual electrodes – can affect the shape of the action potential and/or excite the heart, and thereby interrupt reentrant circles and stop fibrillation. Small resistive obstacles formed by connective tissue or blood vessels in the order of few hundred micrometers in length may suffice to interrupt fibrillatory propagation. Overall, the connective tissue network, especially if it becomes more expressed in disease states or during evolving age, plays an important role in defibrillation.

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Authors and Affiliations

  1. Department of Pathology, Harvard Medical School, Boston, MA, USA

    Andre G. Kleber

  2. Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute, Calgary, AB, Canada

    Anne M. Gillis

Authors
  1. Andre G. Kleber
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  2. Anne M. Gillis
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Correspondence to Andre G. Kleber .

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Editors and Affiliations

  1. Department of Biomedical Engineering, The George Washington University, Washington, DC, USA

    Igor R. Efimov

  2. National Heart & Lung Institute, Imperial College London, London, UK

    Fu Siong Ng

  3. Philips EPD Solutions, Cambridge, MA, USA

    Jacob I. Laughner

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Kleber, A.G., Gillis, A.M. (2021). The Role of Microscopic Tissue Structure in Defibrillation. In: Efimov, I.R., Ng, F.S., Laughner, J.I. (eds) Cardiac Bioelectric Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-63355-4_11

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  • DOI: https://doi.org/10.1007/978-3-030-63355-4_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-63354-7

  • Online ISBN: 978-3-030-63355-4

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