Quatrefoil Reentry Caused by Burst Pacing

Background: Experiments and clinical studies have shown that high‐frequency (burst) pacing can induce reentry and fibrillation without a strong shock. We hypothesize that a train of weak stimuli induces quatrefoil reentry, and investigate the mechanism and threshold for this mode of reentry induction. Methods: We apply a train of weak stimuli at different pacing rates to determine the threshold necessary to induce quatrefoil reentry. Numerical calculations are used to simulate cardiac tissue, based on the bidomain model with unequal anisotropy ratios. We consider both anodal and cathodal stimuli. Results: Quatrefoil reentry is initiated using much smaller currents during burst pacing (0.9 mA) compared to a single premature pulse (8.6 mA). As we varied the pacing rate, we observed reentry at the border between different modes of phase locking, such as between 1:1 and 2:1 responses. Conclusion: Burst pacing can significantly reduce the threshold for reentry. However, the extreme sensitivity of reentry induction to the exact number of stimuli in the pulse train makes the method difficult to use as a consistent, reproducible way to induce reentry.