A Quantitative Model for the Ventricular Response During Atrial Fibrillation

We review the principal statistical properties of the RR interval sequence during atrial fibrillation. A simple quantitative electrophysiologic model is presented which successfully accounts for these statistical features. In this model the atrioventricular junction (AVJ) is treated as a single cell equivalent characterized by a refractory period and spontaneous rate of phase 4 depolarization. The atria are presumed to bombard the AVJ with impulses that arrive randomly in time; each impulse induces a partial depolarization of the AVJ equivalent cell. We show that other models for the ventricular response during atrial fibrillation (e. g., concealed conduction models) do not adequately account for the salient statistical features of the RR interval sequence. The present model may be utilized to characterize a sequence of RR intervals recorded from a given individual in terms of the numerical magnitudes of the model's four parameters: the mean rate at which atrial impulses bombard the AVJ, the relative amplitude of the impulses, the relative rate of spontaneous phase 4 depolarization of the AVJ equivalent cell, and the refractory period of the AVJ equivalent cell. Such a characterization may be useful in studying mechanisms of drug action and interaction, as well as potentially offering a quantitative means for optimizing pharmacologic manangement of chronic atrial fibrillation.