The effect of lidocaine on components of excitability in long mammalian cardiac Purkinje fibers

In contrast to the usual microelectrode techniques employing extracellular tissue stimulation, the double microelectrode technique of intracellular constant current application and intracellular transmembrane voltage recording permits quantitative definition of the components of cardiac excitability. This technique was employed to assess the effect of lidocaine, in a concentration equivalent to clinically effective antiarrhythmic plasma levels (5 mug/ml), on membrane characteristics, cable properties, strength-duration curves and change-duration curves in long sheep Purkinje fibers in normal Tyrode's solution at [K]0 = 4.0 mM. As determined by small hyperpolarizing pulses, lidocaine increased membrane conductance (GM) where GM approximates membrane potassium conductance (GM congruent to GK congruent to gK1) and decreased both the membrane length (lambdam) and time (taum) constants. Lidocaine shifted non-normalized strength-duration curves (threshold current, Ith, vs. current duration, t) and charge-duration curves (charge threshold th, vs. t) upward without altering either the resting transmembrane voltage (Vr) or threshold voltage (Vth). Normalized strength-duration curves and charge-duration curves, however, were superimposable during the control and lidocaine periods. This is best explained by lidocaine altering passive resistance-capacitance properties by increasing membrane potassium conductance without influencing active generator properties dependent on sodium conductance. Lidocaine did not alter the passive or active membrane properties relevant to conduction velocity. By increasing membrane potassium conductance, lidocaine decreases excitability in long Purkinje fibers by increasing Ith without altering Vr or Vth, by increasing Qth; by decreasing lambdam and by rendering local circuit currents less effectual in eliciting an action potential.

Effect of intracellular injection of calcium and strontium on cell communication in heart

1. The influence of Ca and Sr on the electrical coupling of canine Purkinje cells was investigated by injecting the ions electrophoretically into the cytoplasm. 2. It was found that the intracellular injection produced electrical uncoupling which was spontaneously reversed. 3. No change in resting potential of the cell adjacent to the injection site was found except in those fibres not completely healed. 4. The input resistance of the injected cell increased concomitantly with the establishment of the electrical uncoupling. 5. Caffeine (6mM), added to the extracellular fluid, reduced the rate of spontaneous recoupling. Reduction of temperature of the Tyrode solution had the same effect. 6. The abolition of cell communication produced by Ca injection seems to indicate that the ion plays an important role in the control of junctional conductance in heart fibres.

Effect of transmembrane potential on the manifestations of ouabain toxicity in sheep cardiac Purkinje fibres

The effect of membrane potential on the manifestations of ouabain-induced alterations in the electrical activity of shortened sheep cardiac Purkinje fibres was studied by a microelectrode technique. The level of membrane potential was modulated by passing intracellular polarizing current. It was found that the toxic electrical effects induced by exposure to ouabain vary according to the level of membrane potential.

Electrophysiology and pharmacology of cardiac arrhythmias. VIII. Cardiac effects of diphenylhydantoin. B

DPH is highly effective against both atrial and ventricular arrhythmias resulting from digitalis toxicity and should be considered one of the primary antiarrhythmic drugs in this clinical situation. Clinical studies have indicated that DPH, for the most part, is effective against atrial arrhythmias and not markedly effective against ventricular arrhythmias associated with acute or chronic cardiac disease. For the latter ventricular arrhythmias, DPH is usually considered only after other antiarrhythmic drug therapy has failed. Studies on the mechanisms responsible for the antiarrhythmic effects of DPH are, as yet, inconclusive, There is good evidence that its actions differ from those of the commonly used drugs with local anesthetic effects. The extent to which it exerts direct effects on the heart which are therapeutically relevant remains to be demonstrated; further, there is solid evidence that its effects on the central nervous system may be of prime importance in its antiarrhythmic efficacy.

Reconstruction of the electrical activity of cardiac Purkinje fibres

1. The electrical activity of Cardiac Purkinje fibres was reconstructed using a mathematical model of the membrane current. The individual components of ionic curent were described by equations which wee based as closely as possible on previous experiments using the voltage clamp technique. 2. Membrane action potentials and pace-maker activity were calculated and compared with time course of underlying changes in two functionally distinct outeard currents, iX1 and iK2. 3. The repolarization of the theoretical action potential is triggered by the onset of iX1, which becomes activated over the plateau range of potentials. iK2 also activates during the plateau but does not play a controlling role in the repolarization. Hwever, iK2 does govern the slow pace-maker depolarization through its subsequent deactivation at negative potentials. 4. The individual phases of the calculated action potential and their 'experimental' modifications were compared with published records. The upstroke is generated by a Hodgkin-Huxley type sodium conductance (gNa), and rises with a maximum rate of 478 V/sec, somewhat less than experimentally observed values ( up to 800 V/sec). The discrepancy is discussed in relation to experimental attempts at measuring gNa. 5. The ole of the transient outward chloride current (called igr) was studied in calculations of the rapid phase of repolarization and 'notch' configuration...

Multiple effects of calcium antagonists on plateau currents in cardiac Purkinje fibers

We studied the influence of Mn, La, and D600 on action potentials and plateau currents in cardiac Purkinje fibers. The Ca antagonists each abolished the second inward current, but they failed to act selectively. Voltage clamp experiments revealed two additional effects: decrease of slow outward current (iotachi) activation, and increase of net outward time-independent plateau current. These effects occurred at inhibitor concentrations used in earlier studies, and were essential to the reconstruction of observed Ca antagonist effects on electrical activity. The inhibitory influence of Mn, La, and D600 on iotachi suggested that iotachi activation might depend upon prior Ca entry. This hypothesis was not supported, however, when [Ca]omicron was varied: elevating [Ca]omicron enhanced Ca entry, but iotachi was nevertheless depressed. Thus, the results suggested instead that Ca antagonists and Ca ions have rather similar effects on iotachi, possibly mediated by changes in membrane surface charge.

Temperature sensitivity of outward current in cardiac Purkinje fibers. Evidence of electrogenicity of active transport

1. In cardiac Purkinje fibers the temperature sensitivity of the membrane current flowing after 2 sec in response to depolarizing clamp steps was recorded. When the temperature was quickly lowered (30 sec) from 37 degrees C to 20 degrees C for a period of 2 min the outward current was markedly reduced. The effect was immediately reversed upon rewarming. The reduction in outward current on cooling was most pronounced between 30 degrees C and 20 degrees C. 2. In the range of anomalous rectification cooling to 20 degrees C shifted the i.v. relation in a negative direction by a constant amount of 20 nA. Outside this potential range (negative to -80 mV and positive to -45 mV) the slope conductance was reduced with a Q10 of about 1.3. 3. In the presence of dihydroouabain cooling did not further reduce the outward current in the potential range of anomalous rectification. However, negative to -80 mV and positive to -40 mV the slope conductance was reduced. The results support the view that part of the outward current is generated by an electrogenic sodium pump which is inhibited by cooling.

Electrophysiologic effects of isoproterenol on cardiac conduction system in man

The effects of isoproternol (ISOP) on the functional properties of the A-V conduction system were studied in 16 patients using His-bundle recordings and the atrial extrastimulus technique. In all patients, ISOP at an infusion rate of 1 mcg. per minute resulted in sinus acceleration and enhancement of A-V nodal conduction, but had no effect on His-Purkinje conduction time. ISOP significantly decreased both functional and effective refractory periods of the A-V node. The relative refractory period of the His-Purkinje system decreased by a small amount in five patients in whom the parameter could be compared before and after the drug.

The cardiac pharmacology of tolbutamide

Recent clinical studies have suggested an association of tolbutamide therapy with an increased incidence of cardiovascular deaths. Due to the paucity of information concerning the acute cardiac actions of tolbutamide, the effects of this agent upon cardiac contractility and automaticity were examined under in vivo and in vitro conditions in rabbit, cat and dog heart muscle preparations. Tolbutamide (10(-6) to 3 x 10(-3) M) produced a biphasic inotropic response with a peak positive inotropic response at 3 X 10(-3) M which was 13.7 +/- 5.1% of the maximal obtainable increase in tension. Similar studies in cat papillary muscle resulted in a response that averaged 19% of the maximal increase in contractile force. In contrast, canine papillary muscles as well as the intact canine heart failed to develop a positive inotropic response to tolbutamide. Responses of rabbit atrial strips to isoproterenol were not potentiated by previous exposure to tolbutamide. Exposure of rabbit atria to theophylline, 2.5 X 10(-4) M, did not potentiate the inotropic effects of tolbutamide. Stidies in spontaneously beating rabbit right atria and cat papillary muscle-Purkinje fiber preparations demonstrated that tolbutamide does not have the potential to augment automaticity in these tissues. In intact dog heart, the intracoronary administration of tolbutamide did not lead to disturbances in cardiac rhythm, providing additional evidence that tolbutamide does not increase ventricular automaticity. It is concluded that tolbutamide possess a species-specific positive inotropic effect in rabbit and cat but not in the dog. The inotropic effect is small when compared to the maximum inotropic response and is observed only in vitro. Tolbutamide lacks the ability to enhance cardiac pacemaker activity. These data do not support the conclusions of previous investigatirs concerning the possible deleterious cardiac effects of tolbutamide.

Diphenylhydantoin and lidocaine modification of A-V conduction in halothane-anesthetized dogs

The effect of halothane on A-V conduction was evaluated in gods during atrial pacing using the technique of His-bundle electrocardiography. In addition, the effects of lidocaine and diphenylkydantoin (DPH) on A-V conuction were examined during halothane anesthesia. Effects of these drugs on three subintervals of A-V conduction were compared. These included the -H (stimulus atifact of His-bundle deflection-atrioventricular conduction), H-Q (His-budnle deflection onset of QRS complex-His-Purkinje conduction), and H-S intervals(His-bundle delfection to end of QRS COmplex-total intraventricular conduction). Linear regression best described the relationship between duration of interval (P-H, H-V,and H-S) and heart rate during incremental increases in the atrial paced rate. Data from these experiments were fitted to a multiple lenear regression model that predicted the effect of increasing concentrations of halothan, lidocaine, and DPH on slope and intercept coefficients. In creasing concentrations of halothan ( 30 and 45 mg/100 ml arterial). Both lidocaine and DPH further depressed conduction at all levels of halothan anesthesia. The P-H interval was particularly sensitive todrug effefts. This may represent potentiation of the normal slowing of conduction through the AVnode in response to incremental increases in heart rate (fatigue response.) We conclude thatboth lidocaine and DPH fail to reverse the depressant effect of halothane on A-V conduction. This may explain their ineffectiveness in treating certain types of arrhythmias during halothane anesthesia.

Effect of manganese chloride and Verapamil on automaticity of digitalized Purkinje fibers

The effects of manganese chloride (MnCl2) and verapamil on automaticity of digitlazied Purkinje fibers were studied using conventional microelectrode techniques. The stduied wer made in isolated, spontaneously beating Purkinje prearations. Quabain alone consistently increased the automatic rate, whereas no such increase was observed when the preparations were superfused with a mixture of ouabain adn MnCl2. MnCl2 was also shown to be effective is suppressing the enhanced automaticity induced by ouabain. Mncl2 alone did not have a significant effect on the spontaneous rate of Purkinje fibers. The effect of verapamil was similar to that of MnCl2 in preventing and suppressing the ouabain-induced increase in automaticity. MnCl2 and verapamil have been shown to inhibt tha slow inward calcium current of cardiac fibers. The results therefore suggest that an inward calcium ion current may play a role in the development of digitalis-induced increase in the stope of phase 4 depolarization in Purkinje fibers.

Ouabain-induced changes in electrophysiologic properties of neonatal, young and adult canine cardiac Purkinje Fibers

Young patients frequently require higher concentrations of digitalis per kilogram of body weight or per square meter of surface area than adults to induce digitalis effect or toxicity. In order to investigate the electrophysiologic basis for this observation, we used standard microelectrode techniques to study the effects of ouabain on action potential characteristics of cardiac Purkinje fibers of neonatal (1-7 day), 4 to 7 week and adult dogs. Purkinje fibers were stimulated at a 500-msec cycle length. Action potentials were recorded during control Tyrode's perfusion and 23.5 minutes after onset of superfusion with ouabain, 2 X 10(-7) M (10% ouabain-3H). The Purkinje fibers were then assayed for ouabain uptake. Ouabain accelerated repolarization and decreased action potential amplitude, resting membrane potential and maximum upstroke velocity of phase O. Changes were greatest in the adults, least in the neonates. Ouabain increased the slope of phase 4 depolarization in 10 to 12 adults, 7 of 16- 4 to 7-week puppies and 0 of 12 neonates. Hence, ouabain induced lesser changes in the action potentials of Purkinje fibers taken from young animals. These results suggest that Purkinje fiber sensitivity to ouabain effects increases with age.

Purkinje repolarization as a possible cause of the U wave in the electrocardiogram

Our recent clinical studies suggest that the U wave represents Purkinje repolarization. To test this hypothesis, transmembrane potentials of Purkinje fibers (P) and the ventricular muscle (V) were simultaneously recorded from canine P-V preparations perfused in a tissue bath, and effects of various factors causing prominent U waves were studied. These include low stimulating frequency (bracycardia), low potassium (K) concentration, hypothermia, and quinidine. Bracycardia increased the difference between action potential duration of P and V, and decreased the rate of repolarization in P. Similarly, the difference of P and V action potential duration was increased markedly by low K and hypothermia, and slightly by quinidine, while the slope of phase 3 was significantly decreased by all these factors. In several intact animals either hypokalemia or hypothermia was produced using hemodialysis or extracorporeal circulation, and recorded electrocardiograms were compared with the P and V action potentials obtained under similar perfusing conditions in subsequent tissue bath study. Such comparison revealed a good temporal correlation between phase 3 repolarization in P and the electrocardiographic U wave. These results, although indirect, appear to support the theory that P repolarization caused the genesis of the U wave.

Effects of AY-22,241 (Actodigin) on electrical and mechanical activity of cardiac tissues

AY-22,241 (Actodigin) is a new rapid-acting semisynthetic cardiotonic steroid. In experiments on contractility of cat papillary muscle, Actodigin (2 times 10(-7) to 4 times 10(-6) M) produced a dose-dependent positive inotropic effect, a marked increase in the maximum rate of force development, and no change in resting tension. Electrophysiologic studies performed with microelectrode techniques on isolated Purkinje fibers superfused with Tyrode solution, revealed dose-dependent decreases in resting membrane potential, action potential amplitude and duration, and the maximum rate of rise of phase 0 (Vmax). Purkinje fibers superfused with extracorporeally circulated blood from a donor dog receiving 0.075 mg/kg/min Actodigin showed small decreases in resting membrane potential preceding the onset of donor premature ventricular contractions. Progressive decreases in resting membrane potential, action potential amplitude and duration, and Vmax accompanied donor ventricular tachycardia. All effects were rapidly reversible, and compared to ouabain, equi-inotropic concentrations of Actodigin caused significantly less electrophysiologic toxicity.

Electrophysiology and pharmacology of cardiac arrhythmias. VI. Cardiac effects of verapamil

It is clear from clinical and experimental data that have been reported thus far that verapamil is highly effective in the therapy of cardiac arrhythmias, and that it acts by a different mechanism than most of the commonly used antiarrhythmic drugs. The available clinical data indicate that on intravenous administration verapamil is as good as and perhaps superior to quinidine, procainamide and propranolol for the therapy of many atrial arrhythmias. Unfortunately the extent to which it is useful as longterm prophylaxis has not yet been reported, nor has its toxicity during protracted oral administration. The effects of verapamil on cardiac action potentials clearly indicate that it modifies the slow response to a much greater extent than the fast response. Studies of cardiac tissues from diseased human atria have indicated that slow response action potentials occur frequently. It is possible that such action potentials are responsible for the reentrant and automatic arrhythmias which occur in association with clinical cardiac disease. Whether the efficacy of verapamil in the therapy of atrial arrhythmias is primarily due to abolishing slow response activity in diseased atrial tissues or to suppression of propagation through the atrioventricular node is uncertain. However, it is likely that the therapeutic action of the drug may result from altered propagation of an arrhythmia through the atrioventricular junction as well as from the effects of the drug on diseased atrial and ventricular tissues.

The effects of dimethyl quaternary propranolol on the electrophysiologic properties of canine cardiac Purkinje fibers

The effects of dimethyl quaternary propranolol (UM-272) on electrophysiologic properties of canine cardiac Purkinje fibers (PF) were studied using standard microelectrode techniques. In PF superfused with Tyrode's solution, the effects of UM-272, 10- minus 7 to 10- minus 5 M, were studied. In other experiments, UM-272, 3 mg/kg, was injected into donor animals whose blood was used to superfuse isolated PF. Antiarrhythmic concentrations of UM-272 decreased action potential (AP) amplitude, phase 0 upstroke velocity, membrane responsiveness, AP duration and the effective refractory period (the decrease in the effective refractory period was less than that in AP duration). Automaticity of spontaneously firing PF was suppressed. As perfusate potassium concentration was increased, the magnitude of UM-272 effect was accentuated. When the actions of equimolar concentrations of UM-272 and propranolol on PF AP were compared, propranolol attained a steady-state effect more rapidly and tended to depress the AP more markedly. UM-272 did not block epinephrine-induced increases in PF automaticity or the adenylate cyclase activation of PG homogenates induced by epinephrine. These studies indicate that UM-272 has direct effects on the PF AP similar to those of propranolol, but lacks the beta blocking properties of the latter.