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. Author manuscript; available in PMC: 2013 Jan 24.
Published in final edited form as: Circulation. 2012 Jan 24;125(3):539–549. doi: 10.1161/CIRCULATIONAHA.111.033563

Figure 3. Theoretical paradigm for differential mechanisms of alternans in normal and diseased hearts.

Figure 3

In the diseased heart, cellular alternans requires a trigger event and the appropriate substrate to develop. A trigger event alone is sufficient to induce alternans even in the normal heart, however, it requires supra-physiologic heart rates. In the diseased heart, however, the presence of an appropriate sub-cellular substrate makes more favorable the conditions for alternans development, and thus the lower heart rate alternans onset.