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Cardiac physiology

A last wave from the dying heart

Nature volume 392, pages 20–21 (1998)Cite this article

Throughout our lives the heart beats rhythmically — synchronized contraction of the ventricles pumps blood through the body. But during the last few minutes of life (in almost all non-violent deaths), contraction of the ventricular muscle is no longer synchronized. Instead, the ventricles writhe and fibrillate at a frequency some ten times faster than that of the heart rate. If the fibrillating heart is held in your hand it feels like a ball of writhing worms, quivering chaotically. It no longer ejects blood, and death is imminent.

The contraction of cardiac muscle cells is triggered by electrical excitation. Each beat is driven by a wave of excitation, spreading out from the pacemaker region of the heart — the sino-atrial node, which is autorhythmic — and through the entire organ. If this pattern of propagation breaks down, fibrillation may result. During fibrillation, an irregular component appears in electrocardiogram recordings at about 8-10 Hz. This indicates that there is temporal order in the electrical activity that produces fibrillation4, consistent with some remaining spatio-temporal patterning or order in the activity of the fibrillating heart. Fibrillation is thought to result from so-called re-entrant waves of excitation, which rotate around a core (as a spiral wave in two dimensions) or a filament (as a scroll in three dimensions). The electrophysiological structures that emit such rotating waves — rotors — arise in excitable models of cardiac tissue5,6. But although such ordered propagation (as spiral or scroll waves) is found in computational models of the heart7, it has not been demonstrated in situ.

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Figure 1: Propagation of a simple re-entrant wave in an anatomically detailed model of the canine ventricle.

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  1. the Centre for Nonlinear Studies, University of Leeds, LS2 9JT, Leeds, UK

    Arun V. Holden

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Holden, A. A last wave from the dying heart. Nature 392, 20–21 (1998). https://doi.org/10.1038/32044

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