Imaging of Ventricular Fibrillation and Defibrillation: The Virtual Electrode Hypothesis

  • Bastiaan J. Boukens
  • Sarah R. Gutbrod
  • Igor R. Efimov
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 859)


Ventricular fibrillation is the major underlying cause of sudden cardiac death. Understanding the complex activation patterns that give rise to ventricular fibrillation requires high resolution mapping of localized activation. The use of multi-electrode mapping unraveled re-entrant activation patterns that underlie ventricular fibrillation. However, optical mapping contributed critically to understanding the mechanism of defibrillation, where multi-electrode recordings could not measure activation patterns during and immediately after a shock. In addition, optical mapping visualizes the virtual electrodes that are generated during stimulation and defibrillation pulses, which contributed to the formulation of the virtual electrode hypothesis. The generation of virtual electrode induced phase singularities during defibrillation is arrhythmogenic and may lead to the induction of fibrillation subsequent to defibrillation. Defibrillating with low energy may circumvent this problem. Therefore, the current challenge is to use the knowledge provided by optical mapping to develop a low energy approach of defibrillation, which may lead to more successful defibrillation.


Optical mapping Fibrillation Defibrillation Arrhythmias Imaging Virtual electrodes Stimulation Heart Re-entry Shock 


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Bastiaan J. Boukens
    • 1
  • Sarah R. Gutbrod
    • 1
  • Igor R. Efimov
    • 1
    • 2
  1. 1.Department of Biomedical EngineeringWashington UniversitySt LouisUSA
  2. 2.L’Institut de rythmologie et modélisation cardiaque LIRYCUniversité de BordeauxBordeauxFrance

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