The role of endocardial trabeculations in low-energy defibrillation

Abstract

Recent novel low-voltage defibrillation protocols have been shown to terminate arrhythmias in animals with significantly reduced energies compared to standard shocks. Although the importance of finescale structural heterogeneity in driving this process through the formation of virtual electrodes has been suggested, a full understanding of these phenomena is still lacking. Here, we perform a detailed computational investigation into how specific geometrical properties of endocardial trabeculations (size, relative curvature, neighbouring proximity) affects the applied electric field strength required to generate a propagated action potential from surface virtual electrodes. We demonstrate that the applied field for propagation is lower for a single compared to multiple neighbouring trabeculations, and decreases as the structure width increases. Initial propagation occurs at trabeculation edges for single and’tips’ for multiple structures. Our findings may help optimise variables associated with low-voltage protocols, advancing clinical application.