A computer simulation study of the efficacy of uniform field pacing for the prevention of ventricular tachyarrhythmia

Summary

A quantitatively-reliable computer model of the human heart could be a very useful tool for the analysis and development of potential tachyarrhythmia therapies. In this article, we present a new discrete cellular automata (CA) model of the human ventricle that allows representation of important quantitative aspects of cardiac excitation waves. We use this model to analyze a hypothetical technique for preemptive antitachycardia pacing using spatially-uniform, low-energy shocks. Because of the computational efficiency and relative simplicity of the CA model, we can perform rapid simulations of a large number of pacing interventions on a statistical ensemble of two-dimensional ventricular substrates with topology and dimensions similar to the human ventricular epicardial surface. This allows us to obtain a good statistical profile of the intervention‘s efficacy and proarrhythmic potential. Our study results suggest that while spatially-uniform, low-energy preemptive pacing shocks are frequently successful at preventing tachyarrhythmia, they are often proarrhythmic. The simplicity of our CA model structure and the clear physiological interpretation of its parameters allows us to examine the mechanisms of arrhythmia prevention and spurious induction by the pacing shocks in terms of the generic properties of the waves. We believe such an approach can potentially be very useful for the preliminary analysis of a wide variety of antiarrhythmic interventions, both electrical and pharmacological.