Control of cardiac alternans by mechanical and electrical feedback.

A persistent alternation in the cardiac action potential duration has been linked to the onset of ventricular arrhythmia, which may lead to sudden cardiac death. A coupling between these cardiac alternans and the intracellular calcium dynamics has also been identified in previous studies. In this paper, the system of PDEs describing the small amplitude of alternans and the alternation of peak intracellular Ca(2+) are stabilized by optimal boundary and spatially distributed actuation. A simulation study demonstrating the successful annihilation of both alternans on a one-dimensional cable of cardiac cells by utilizing the full-state feedback controller is presented. Complimentary to these studies, a three variable Nash-Panfilov model is used to investigate alternans annihilation via mechanical (or stretch) perturbations. The coupled model includes the active stress which defines the mechanical properties of the tissue and is utilized in the feedback algorithm as an independent input from the pacing based controller realization in alternans annihilation. Simulation studies of both control methods demonstrate that the proposed methods can successfully annihilate alternans in cables that are significantly longer than 1 cm, thus overcoming the limitations of earlier control efforts.