Models of defibrillation of cardiac tissue

Heterogeneities, such as gap junctions, defects in periodical cellular lattices, intercellular clefts and fiber curvature allow one to understand the effect of an electric field in cardiac tissue. They induce membrane potential variations even in the bulk of the myocardium, with a characteristic sawtooth shape. The sawtooth potential, induced by heterogeneities at large scales (tissue strands) can be more easily observed, and lead to stronger effects than the one induced at the cellular level. In the generic model of propagation in cardiac tissue (FitzHugh), 4 mechanisms of defibrillation were found, two mechanisms based on excitation (E-A, E-M), and two-on de-excitation (D-A, D-M). The lowest electric field is required by an E-M mechanism. In the Beeler-Reuter ionic model, mechanism D-M is impossible. We critically review the experimental basis of the theory and propose new experiments. (C) 1998 American Institute of Physics.