Art Winfree and Defibrillation

Chaos: Making a New Science,
by James Gleick.

Yesterday I posted an excerpt from Chaos: Making a New Science. Here’s a dirty little secret: I haven’t read this book yet. I own a copy, and hope to read it soon (if we’re still locked down by the coronavirus once the semester is over, I’ll have plenty of time to read!). I did thumb through it, and found another interesting story. Regular readers of this blog know that the mathematical biologist Art Winfree played a key role in my development as a scientist. In Chaos, James Gleick tells how Winfree teamed up with Duke cardiologist Ray Ideker to study defibrillation.

Winfree told the story of an early researcher, George Mines, who in 1914 was twenty-eight years old. In his laboratory at McGill University in Montreal, Mines made a small device capable of delivering small, precisely regulated electrical impulses to the heart.

“When Mines decided it was time to begin work with human beings, he chose the most readily available experimental subject: himself,” Winfree wrote. “At about six o’clock that evening, a janitor, thinking it was unusually quiet in the laboratory, entered the room. Mines was lying under the laboratory bench surrounded by twisted electrical equipment. A broken mechanism was attached to his chest over the heart and a piece of apparatus nearby was still recording the faltering heartbeat. He died without recovering consciousness.”

One might guess that a small but precisely timed shock can throw the heart into fibrillation, and indeed even Mines had guessed it, shortly before his death. Other shocks can advance or retard the next beat, just as in circadian rhythms. But one difference between hearts and biological clocks, a difference that cannot be set aside even in a simplified model, is that a heart has a shape in space. You can hold it in your hand. You can track an electrical wave through three dimensions.

To do so, however, requires ingenuity. Raymond E. Ideker of Duke University Medical Center read an article by Winfree in Scientific American in 1983 and noted four specific predictions about inducing and halting fibrillation based on nonlinear dynamics and topology. Ideker didn’t really believe them. They seemed too speculative and, from a cardiologist’s point of view, so abstract. Within three years, all four had been tested and confirmed, and Ideker was conducting an advanced program to gather the richer data necessary to develop the dynamical approach to the heart. It was, as Winfree said, “the cardiac equivalent of a cyclotron.”

The traditional electrocardiogram offers only a gross one-dimensional record. During heart surgery a doctor can take an electrode and move it from place to place on the heart, sampling as many as fifty or sixty sites over a ten-minute period and thus producing a sort of composite picture. During fibrillation this technique is useless. The heart changes and quivers far too rapidly. Ideker’s technique, depending heavily on real-time computer processing, was to embed 128 electrodes in a web that he would place over a heart like a sock on a foot. The electrodes recorded the voltage field as each wave traveled through the muscle, and the computer produced a cardiac map.

Ideker’s immediate intention, beyond testing Winfree’s theoretical ideas, was to improve the electrical devices used to halt fibrillation. Emergency medical teams carry standard versions of defibrillators, ready to deliver a strong DC shock across the thorax of a stricken patient. Experimentally, cardiologists have developed a small implantable device to be sewn inside the chest cavity of patients thought to be especially at risk, although identifying such patients remains a challenge. An implantable defibrillator, somewhat bigger than a pacemaker, sits and waits, listening to the steady heartbeat, until it becomes necessary to release a burst of electricity. Ideker began to assemble the physical understanding necessary to make the design of defibrillators less a high-priced guessing game, more a science.

You can learn more about Winfree, nonlinear dynamics, the heart, and defibrillation in Intermediate Physics for Medicine and Biology.

James Gleick on Chaos: Making a New Science.

https://www.youtube.com/watch?v=3orIIcKD8p4

Ray Ideker discusses Mechanisms of
Ventricular Fibrillation and Defibrillation.
https://www.youtube.com/watch?v=94eU2ztM_uU