Iteration of the Human Atrioventricular (AV) Nodal Recovery Curve Predicts Many Rhythms of AV Block

The spontaneous rhythmic activity of aggregates of embryonic chick heart cells was perturbed by the injection of single current pulses and periodic trains of current pulses. The regular and irregular dynamics produced by periodic stimulation were predicted theoretically from a mathematical analysis of the response to single pulses. Period-doubling bifurcations, in which the period of a regular oscillation doubles, were predicted theoretically and observed experimentally.

Extremely complex frequency-dependent patterns of excitation and impulse propagation can be shown in cardiac tissues. Such complex behaviour can be analysed using methods derived from chaos theory, which is concerned with the non-linear dynamics of deterministic systems that have irregular periodicities as well as an exquisite sensitivity to the initial conditions. We report here that the general response patterns of non-oscillatory cardiac conducting tissues, when driven rhythmically by repetitive stimuli from their surroundings, are similar to those of other deterministic systems showing chaotic dynamics. Such patterns include phase locking, period-doubling bifurcation and irregular activity. We have used electrophysiological techniques and analytical arguments to explain this unforeseen behaviour and to provide some key information about its mechanisms. The study of these dynamics is of general application to the understanding of disordered phenomena in excitable media, and may provide new insight about the origin of fatal cardiac arrhythmias.