A model study of extracellular stimulation of cardiac cells.

Point source extracellular stimulation of a myocyte model was used to study the efficacy of excitation of cardiac cells, taking into account the shape of the pulse stimulus and its time of application in the cardiac cycle. The myocyte was modeled as a small cylinder of membrane (10 microns in diameter and 100 microns in length) capped at both ends and placed in an unbounded volume conductor. A Beeler-Reuter model modified for the Na+ dynamics served to simulate the membrane ionic current. The stimulus source was located on the cylinder axis, close to the myocyte (50 microns) in order to generate a nonlinear extracellular field (phi e). The low membrane impedance associated with the high frequency component of the make and break of the rectangular current pulse leads to a current flow across the membrane and an abrupt change in intracellular potential (phi i). Because the intracellular space is very small, phi i is nearly uniform over the length of the myocyte and the membrane potential (V = phi i-phi e) is governed by the applied field phi e. There is then a longitudinal gradient of membrane polarization which is the inverse of the gradient of extracellular potential. With an anodal (positive) pulse, for instance, the proximal portion of the myocyte is hyperpolarized and the distal portion is depolarized. Based on this principle and considering the voltage-dependent activation/inactivation dynamics of the membrane, it is shown that a cathodal (negative) pulse is the most efficacious stimulus at diastolic potentials, an anodal current is preferable during the plateau phase of the action potential, and a biphasic pulse is optimal during the relative refractory phase. Thus a biphasic pulse would constitute the best choice for maximum efficacy at all phases of the action potential.