Spiral wave stability in cardiac tissue with biphasic restitution.

Human ventricular tissue as well as several animal ventricular preparations show a biphasic shape of the action potential duration restitution curve, with a local maximum at low diastolic intervals. We study numerically how the location and properties of this nonmonotonicity affect the stability of spiral waves. We find that, depending on the slopes of the ascending and of the descending parts of the restitution curve, we can have either stable rotation of the spiral wave or spiral breakup. We identify two types of spiral breakup: one due to a steep positive slope and another due to a steep negative slope in the restitution curve. We discuss the differences in their manifestation and possible implications. We also find that increasing the slope of the descending part of the restitution curve increases the meandering of the spiral wave, due to the repeated occurrence of conduction blocks near the spiral wave tip.