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Europace 2005 7(s2):S10-S20; doi:10.1016/j.eupc.2005.05.011
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

Of circles and spirals: Bridging the gap between the leading circle and spiral wave concepts of cardiac reentry

P. Comtoisa,b, J. Knellerb and S. Nattela,b,c,*

aDepartment of Pharmacology and Therapeutics, McGill University McIntyre Medical Sciences Building 3655 Promenade Sir-William-Osler, Montréal, Québec, Canada H3G 1Y6; bThe Research Center, Montreal Heart Institute 5000 Belanger St. E., Montreal, Quebec H1T 1C8, Canada; cDepartment of Medicine and University of Montreal, Montreal Heart Institute 5000 Belanger St. E., Montreal, Quebec, Canada H1T 1C8

The "leading circle model" was the first detailed attempt at understanding the mechanisms of functional reentry, and remains a widely-used notion in cardiac electrophysiology. The "spiral wave" concept was developed more recently as a result of modern theoretical analysis and is the basis for consideration of reentry mechanisms in present biophysical theory. The goal of this paper is to present these models in a way that is comprehensible to both the biophysical and electrophysiology communities, with the idea of helping clinical and experimental electrophysiologists to understand better the spiral wave concept and of helping biophysicists to understand why the leading circle concept is so attractive and widely used by electrophysiologists. To this end, the main properties of the leading circle and spiral wave models of reentry are presented. Their basic assumptions and determinants are discussed and the predictions of the two concepts with respect to pharmacological responses of arrhythmias are reviewed. A major difference between them lies in the predicted responses to Na+-channel blockade, for which the spiral wave paradigm appears more closely to correspond to the results of clinical and experimental observations. The basis of this difference is explored in the context of the fundamental properties of the models.

Key Words: reentry, leading-circle, spiral wave, pharmacological therapy

*Corresponding author. Department of Medicine and University of Montreal, Montreal Heart Institute, 5000 Belanger St. E., Montreal, Quebec, Canada H1T 1C8. Tel.: +1 514 376 3330; fax: +1 514 376 1355. E-mail address: stanley.nattel{at}icm-mhi.org (S.Nattel).


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