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Virtual Electrode Theory of Pacing

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Cardiac Bioelectric Therapy

Abstract

Twenty years of optical mapping of cardiac electrical activity and mathematical modeling of the cardiac bidomain have provided insight into the basic mechanisms by which electric fields interact with cardiac tissue. We review this research, focusing on our own work on virtual electrodes and cardiac stimulation, which began with observations of adjacent regions of depolarization and hyperpolarization (virtual electrodes) during unipolar stimulation. We describe how this phenomenon leads to break excitation and quatrefoil reentry, controls the shape of the strength-interval curve, is affected by electrical heterogeneities and boundaries, and ultimately provides a foundation for our understanding of cardiac defibrillation. The collective work on the cardiac bidomain provides a strong and well-validated foundation for our understanding of cardiac pacing, magnetocardiography, and defibrillation, and will help usher in a new era of studies on the interactions between membrane potential, calcium, and mechanical deformation.

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Acknowledgments

We are indebted to Allison Price and Don Berry for their painstaking bibliographic, editorial, and graphical assistance in preparing this manuscript. We thank Richard Gray and Franz Baudenbacher for answering innumerable questions in the first edition of this chapter. We gratefully acknowledge the many contributions that our students and collaborators have made to the research that we describe in this chapter. This work was supported originally by the National Institutes of Health grants R01 HL57207 and HL58241. The preparation of this second edition was supported in part by the NIH National Center for Advancing Translational Sciences (NCATS), National Institute of Neurological Disorders and Stroke (NINDS), and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award UH3TR002097.

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Authors and Affiliations

  1. Department of Physics, Oakland University, Rochester, MI, USA

    Bradley J. Roth

  2. Department of Biomedical Engineering, The Vanderbilt Institute for Integrative Biosystems Research and Education, Vanderbilt University, Nashville, TN, USA

    Veniamin Y. Sidorov

  3. Departments of Biomedical Engineering, Molecular Physiology and Biophysics, and Physics and Astronomy, The Vanderbilt Institute for Integrative Biosystems Research and Education, Vanderbilt University, Nashville, TN, USA

    John P. Wikswo

Authors
  1. Bradley J. Roth
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  2. Veniamin Y. Sidorov
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  3. John P. Wikswo
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Correspondence to John P. Wikswo .

Editor information

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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Roth, B.J., Sidorov, V.Y., Wikswo, J.P. (2021). Virtual Electrode Theory of Pacing. 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_12

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  • DOI: https://doi.org/10.1007/978-3-030-63355-4_12

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