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(Circulation Research. 2001;89:1089.)
© 2001 American Heart Association, Inc.

Editorials

Recent Fibrillation Studies

Attempts to Wrest Order From Disorder

Raymond E. Ideker, Jian Huang, Vladimir Fast, William M. Smith

From the Departments of Medicine (R.E.I., J.H., W.M.S.), Biomedical Engineering (R.E.I., V.F., W.M.S.), and Physiology and Biophysics (R.E.I.), University of Alabama at Birmingham, Ala.

Correspondence to Raymond E. Ideker, MD, PhD, University of Alabama at Birmingham, 1530 3rd Ave S, VH B140, Birmingham, AL 35294-0019. E-mail rei@crml.uab.edu

Key Words: fibrillation • reentry • ion channels

Not so long ago, the basic mechanism of the maintenance of fibrillation was thought to be understood, with only the details to be worked out. Whereas the relative roles of reentry and foci were intensely debated during the first half of the twentieth century,¹ by the 1970s, the preponderance of evidence suggested that fibrillation was maintained solely by reentry.^2,3 This reentry was thought to be evanescent and unstable, maintained by wandering wavelets of activation following constantly changing paths of activation and exhibiting frequent conduction block caused by a nonuniform dispersion of refractoriness.^2,4 In the last few years, these cherished ideas have been challenged from several different directions. Clinical data suggest that in some patients with paroxysmal atrial fibrillation, foci arising primarily from the pulmonary veins contribute to both the initiation and maintenance of the arrhythmia.^5–7 Although recent experimental and simulation investigations still point to reentry as the sole mechanism for the maintenance of ventricular fibrillation,^8–11 they suggest that there may be other causes of reentry than the dispersion of refractoriness and other types of reentry than wandering wavelets.

Some of these investigations have dealt with the nonlinear, temporal aspects of the relationship between the activation rate and the refractory period, ie, the restitution curve.^12,13 Other investigations have dealt with the nonlinear, spatial aspects of activation and recovery^8,10,14–16 and, from the study of excitable media, have introduced the concepts of wavefront, wavetail, wavebreak, and rotor as replacements for and improvements upon the classic concepts of activation sequence, recovery pattern, conduction block, . . . [Full Text of this Article]

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