Cardiac electrophysiologic effects of McN-5691, a new calcium-channel blocking antihypertensive agent

The purpose of this study was to evaluate the cardiac electrophysiological effects of McN-5691, a new calcium-channel blocking antihypertensive drug. In anesthetized dogs, the primary electrophysiological effect of McN-5691 was dose-related prolongation of AV-nodal conduction time and refractoriness (0.1-1.0 mg/kg i.v.), which correlated with McN-5691 plasma levels. There were no significant effects on atrial or ventricular conduction times, QTc, or ventricular monophasic action potential duration. This profile was similar to that of verapamil. McN-5691 caused concentration-related, rate-dependent reductions in Vmax and amplitude of slow-response action potentials in guinea pig papillary muscle: ED-20% for depression of Vmax was 0.72 +/- 0.32 microM. Verapamil was more potent in depressing these action potentials: ED-20% for depression of Vmax was 0.03 +/- 0.01 microM. McN-5691 also caused rate-dependent reduction in Vmax and amplitude of canine Purkinje fiber action potentials, but only at relatively high concentrations: ED-20% for depression of Vmax was 55 +/- 12 microM. McN-5691 also reduced the action potential duration (0.3-30 microM) without affecting the slope of phase 4 depolarization and the maximum diastolic potential. Verapamil also reduced Vmax in Purkinje fibers (ED-20% for depression of Vmax was 32 +/- 3 microM) and shortened the action potential duration. The results show that McN-5691 has cardiac electrophysiological effects consistent with blockade of the slow inward calcium current, and that this activity occurs at concentrations well below those having local anesthetic activity. In addition, its lower potency in comparison to verapamil in depressing slow responses suggests a lesser propensity for negative inotropic effects.

State dependence of ethacizin and ethmozin block of sodium current in voltage clamped and internally perfused cardiac Purkinje cells

Ethacizin, a positively charged analog of ethmozin, reduces the cardiac action potential upstroke and blocks peak sodium current (INa). We investigated ethacizin block of INa in 11 cells and ethmozin block in 4 cells at 20 degrees C. Rest block measured as the relative INa decrease for the first pulse in drug after 3 to 6 min at the holding potential was negligible for ethacizin but substantial (16% at 5 microM) for ethmozin. Use-dependent block developed exponentially; the time course of block and relative INa remaining were concentration-dependent. Frequency dependence of block between 0.5 and 4 cps was weak for ethacizin. Varying the depolarization duration from 5 to 100 msec, while keeping the recovery interval constant, did not alter the block by ethacizin. In contrast, prolonging the clamp step in ethmozin from 5 to 100 msec increased the rate and depth of block. Apparent binding rates for each drug were calculated using the assumptions of the guarded receptor model. We conclude that ethacizin blocks INa in a use-dependent manner by binding to a transiently available state such as the open state. In contrast, ethmozin block of INa exhibits both rest block and use-dependent block. Use-dependent block can be attributed to binding to a state (or states) maintained during depolarization such as the inactivated state. With these similar drugs, charge appears to be an important determinant of state-dependent binding.

Frequency-dependent interactions of mexiletine and quinidine on depolarization and repolarization in canine Purkinje fibers

The use of the antiarrhythmic agents mexiletine and quinidine in combination can be clinically beneficial when single agent therapy is ineffective in ventricular tachyarrhythmias. We therefore compared the effects of mexiletine (10 microM), quinidine (10 microM) and a series of their combinations (total concentration 10 microM) in canine cardiac Purkinje fibers driven at a wide range of stimulation frequencies. All treatments depressed Vmax in tissues driven rapidly (cycle length 300 msec), but only with greater than or equal to 5 microM quinidine was Vmax depressed at longer cycle lengths. Moreover, the time constants for development of and recovery from frequency-dependent block were different: short (200-500 msec) for mexiletine, long (3-5 sec) for quinidine and intermediate or biexponential for the combination. Although both drugs depressed Vmax (albeit with different time dependencies), action potential duration at all cycle lengths from 300 to 8000 msec was shortened by mexiletine, lengthened by quinidine and largely unaltered by combinations. Fibers treated with quinidine in low Ko and driven at slow rates developed marked action potential prolongation and abnormal automaticity in the form of early afterdepolarizations; the addition of mexiletine was sufficient to reverse this effect. In summary, mexiletine and quinidine produced different and frequency-dependent effects on depolarization and repolarization. The effects of their combinations reflected these actions, with opposing actions on repolarization at any stimulation rate but additive frequency-dependent depression of Vmax. We conclude that the clinically beneficial effects of this combination may reflect additive frequency-dependent effects on cardiac sodium channels in the face of unaltered repolarization time.

Use-dependent blockade of sodium channels induced by bencyclane in frog skeletal muscle and canine cardiac Purkinje fiber

Applying conventional microelectrode technique, the effect of bencyclane was studied on the maximal rate of rise (Vmax) of the transmembrane action potential in frog skeletal muscle and canine cardiac Purkinje fiber. Bencyclane (10 microM) decreased the Vmax from 333.7 +/- 6.9 V/sec to 302.7 +/- 10.2 V/sec (n = 6, p less than 0.05) in skeletal muscle without changing the resting membrane potential. If repetitive stimulation with different constant cycle lengths was applied, a further, frequency-dependent decrease of Vmax developed in both tissues with similar frequency-dependence. In skeletal muscle bencyclane increased the time of 50% repolarization by 33.3 +/- 2.5% (n = 7, p less than 0.01) and decreased the overshoot potential by 11.3 +/- 0.72 mV (n = 7, p less than 0.01) measured at 250 msec cycle length. In cardiac Purkinje fiber bencyclane shortened the action potential duration (APD90) from 258.3 +/- 15.4 msec to 241.7 +/- 12.1 msec (n = 6, p less than 0.05) without changing the resting membrane potential and action potential amplitude measured at 500 msec cycle length. The comparable size of the Vmax-block at the same cycle lengths observed in skeletal muscle (short APD) and Purkinje fiber (long APD) suggests that the inhibition may by mainly attributed to the open sodium channel population. It was concluded that the antiarrhythmic action of bencyclane, based on the use-dependent blockade of sodium channels, might be an important component of the therapeutic effect of bencyclane.

Antiarrhythmic potential of chloroquine: new use for an old drug

Amiodarone and chlorpromazine are phospholipase inhibitors which produce cytoplasmic inclusion bodies and have important electrophysiologic properties. Chloroquine also inhibits phospholipase activity, resulting in similar inclusion bodies, but electrophysiologic information about this drug is lacking. In this study, the cellular electrophysiologic effects of two doses of chloroquine were examined in sheep Purkinje fibres and ventricular muscle cells. Both concentrations produced a significant reduction in maximum velocity of upstroke of the action potential and prolongation of the action potential duration and refractory period in Purkinje fibres. These effects were observed in the absence of significant changes in threshold of stimulation or action potential amplitude and were partially reversible following washout of the lower drug concentration. In addition to these experimental data, clinical evidence of antiarrhythmic action was determined by administering 500 mg chloroquine daily over nine weeks to six subjects with frequent asymptomatic ventricular premature complexes. In four patients there was a reduction in ventricular ectopy, which recurred when the drug was discontinued, while a fifth patient reverted to sinus rhythm from atrial fibrillation previously resistant to other antiarrhythmic medication. Thus, chloroquine has important electrophysiologic properties. The underlying mechanism of this action remains unproven at the present time.

[Effects of isoprenaline and carbachol on delayed after-depolarization in myocardium]

The effects of isoprenaline and carbachol on the delayed after-depolarization (DAD) induced by acetyl strophanthidin of 2.0 x 10(-7) mol/L were observed in sheep cardiac Purkinje fibers. The amplitude of DAD was enhanced by isoprenaline (1.0--3.0 x 10(-8) mol/L) in a dose-dependent manner and the triggered arrhythmia was induced. Carbachol of 2.0 x 10(-6) mol/L alone had no effect on the amplitude of DAD. When the DAD was enhanced by isoprenaline or the triggered arrhythmia was induced, the same concentration of carbachol could decrease the amplitude of DAD significantly and abolish the triggered arrhythmia. However, carbachol did not attenuate the amplitude of the DAD enhanced by high concentration of calcium, aminophylline or histamine. The results suggest that carbachol can antagonize the enhancement of the DAD caused by isoprenaline. This effect is possibly mediated by activation of the muscarinic receptor, which in turn causes a decrease in the adenyl cyclase activity elevated by the activation of the beta-receptor in the membrane.

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.

Chiral recognition of pinacidil and its 3-pyridyl isomer by canine cardiac and smooth muscle: antagonism by sulfonylureas

Pinacidil, a potassium channel opener (PCO), relaxes vascular smooth muscle by increasing potassium ion membrane conductance, thereby causing membrane hyperpolarization. PCOs also act on cardiac muscle to decrease action potential duration (APD) selectively. To examine the enantiomeric selectivity of pinacidil, the stereoisomers of pinacidil (a 4-pyridylcyanoguanidine) and its 3-pyridyl isomer (LY222675) were synthesized and studied in canine Purkinje fibers and cephalic veins. The (-)-enantiomers of both pinacidil and LY222675 were more potent in relaxing phenylephrine-contracted cephalic veins and decreasing APD than were their corresponding (+)-enantiomers. The EC50 values for (-)-pinacidil and (-)-LY222675 in relaxing cephalic veins were 0.44 and 0.09 microM, respectively. In decreasing APD, the EC50 values were 3.2 microM for (-)-pinacidil and 0.43 microM for (-)-LY222675. The eudismic ratio was greater for the 3-pyridyl isomer than for pinacidil in both cardiac (71 vs. 22) and vascular (53 vs. 17) tissues. (-)-LY222675 and (-)-pinacidil (0.1-30 microM) also increased 86Rb efflux from cephalic veins to a greater extent than did their respective optical antipodes. The antidiabetic sulfonylurea, glyburide (1-30 microM), shifted the vascular concentration-response curve of (-)-pinacidil to the right by a similar extent at each inhibitor concentration. Glipizide also antagonized the response to (-)-pinacidil, but was about 1/10 as potent with a maximal shift occurring at 10 and 30 microM. Glyburide antagonized the vascular relaxant effects of 0.3 microM (-)-LY222675 (EC50, 2.3 microM) and reversed the decrease in APD caused by 3 microM (-)-LY222675 (EC50, 1.9 microM). Nitroprusside did not alter 86Rb efflux, and vascular relaxation induced by sodium nitroprusside was unaffected by sulfonylureas. Thus, the enantiomers of the 3-pyridyl isomer of pinacidil demonstrate enhanced stereospecificity in both canine cardiac and vascular tissues compared to the enantiomers of pinacidil. However, the relative selectivity of pinacidil and its 3-pyridyl isomer for cardiac and vascular smooth muscle remains unaltered. Sulfonylureas antagonize the more potent enantiomers in both tissues, supporting the involvement of an ATP-sensitive potassium channel in the action of PCOs; however, antagonism in canine vascular smooth muscle by sulfonylureas does not resemble classical competitive antagonism.

Developmental electrophysiology of encainide and its major metabolites on the Purkinje fiber action potential

OBJECTIVE

With clinical data suggesting that neonates may be more prone to developing electrophysiologic side effects from encainide, this study investigates the in vitro developmental electrophysiologic effects of encainide and its major metabolites on the action potential parameters of the canine cardiac Purkinje fiber.

METHODS

With standard microelectrode techniques, the in vitro tonic and rate-related effects of encainide, and its major metabolites (3-methoxy-4-hydroxy encainide, MODE, and O-dimethyl encainide, ODE) were investigated using mature and immature canine cardiac Purkinje fibers.

RESULTS

The significant developmental differences in the effects of these compounds on the canine Purkinje fiber illustrated in this study are: (1) 1 x 10(-6) M encainide depresses Vmax in neonatal Purkinje fibers, yet not in the adult. (2) 1 x 10(-6) M MODE lengthens APD90 in the neonate, yet it has no substantial effect in the adult. (3) 1 x 10(-6) M ODE shortens APD90 in the adult, yet it has no appreciable effect on the neonate. (4) Rate-related effects of encainide and ODE are more pronounced in adult Purkinje fibers.

CONCLUSION

In contrast to other in vitro studies on class I antiarrhythmic agents, neonatal canine Purkinje fibers seem to be more sensitive than the adult to the tonic depolarization depressant effect of encainide. This in vitro sensitivity parallels clinical experience with the drug in neonatal patients. Although encainide is no longer available for clinical use, these findings highlight the fact that the immature conduction system may show markedly different sensitivities to different class I agents despite the fact that these agents share similar qualitative pharmacologic properties.

Alpha-adrenoceptor stimulation enhances automaticity in barium-treated cardiac Purkinje fibers

We used intracellular microelectrodes to study the effect of alpha-adrenoceptor stimulation on automaticity of sheep cardiac Purkinje fibers exposed to low (10(-5) - 4 X 10(-5) M) barium concentrations. Concentrations of norepinephrine (NE) (3 X 10(-8) - 3 X 10(-7) M), which did not induce spontaneous activity in the absence of barium, consistently induced or enhanced it (if already present) in the presence of barium. Similar results were obtained in the presence of practolol (10(-6) M), which in 13 out of 17 experiments did not counteract the effect of NE. However, phentolamine (3 X 10(-7) M) caused a slowing or blocking of the spontaneous activity induced by NE in barium-treated preparations either in the presence or in the absence of practolol. We conclude that alpha-adrenergic responsiveness is enhanced in barium-treated Purkinje fibers and that under these experimental conditions, alpha-adrenoceptor stimulation may influence automaticity. The possible mechanisms underlying such effects are discussed.

Senescence-related changes in the responsiveness to ouabain of canine Purkinje fibers

Clinical studies have suggested that old adults are more susceptible to the toxic effects of digitalis than young adults. To test whether this reflects an age-related change in responsiveness to digitalis of cardiac fibers, standard microelectrode techniques were used to study the effects of ouabain (O) on Purkinje fibers (PF) from 5- and 10-year-old beagles. PF driven at cycle length = 600 msec were superfused with O, 2 x 10(-7) M, containing 3% [3H]O for 25 min. PF-O uptake was the same at both ages. Control maximum diastolic potential, action potential amplitude, upstroke velocity (Vmax) and duration to 50% repolarization (APD50) did not differ significantly between the two age groups. However, the effects of O on action potential characteristics and on delayed after depolarizations in PF from the 10 year old PF were significantly greater than that on the 5 year old PF. Additional experiments were done in which we superfused PF from adult and old animals with O for long periods to determine the time-response relationships for ouabain effects on maximum diastolic potential, action potential amplitude, Vmax and APD50. The rate of change was 2 to 3 times greater in the 10 than the 5 year old PF. After 55 min of O, only 2 of 7 10-year-old PF remained excitable, compared with 6 of 6 5-year-old PF. In conclusion, PF from old dogs show greater responsiveness to the toxic effects of O than those of younger adults, explaining in part the clinical observation of increased digitalis toxicity with age.

Different forms of spontaneous discharge induced by strophanthidin in cardiac Purkinje fibers

The effect of strophanthidin on spontaneous discharge in canine cardiac Purkinje fibers perfused in vitro was studied during periodic interruptions (pauses) of the electrical drive. The results show that 1) strophanthidin initially increases the slope of diastolic depolarization and thereby induces a slow rhythm that accelerates progressively during the pause and becomes faster during the increasing strophanthidin inotropy; 2) oscillatory potentials appear only when strophanthidin inotropy reaches its peak (or actually declines) and may cause either a few fast action potentials during the pause or a fast rhythm that eventually overcomes the driven beats; 3) the slow rhythm is eliminated by cesium; 4) the fast rhythm is eliminated by tetrodotoxin; and 5) oscillatory potentials caused by high calcium, norepinephrine, or low potassium are similarly affected by cesium or tetrodotoxin. It is concluded that strophanthidin enhances diastolic depolarization, thereby causing the slow rhythm, and induces oscillatory potentials, thereby causing the fast rhythm. Only the oscillatory potentials are related to calcium overload as determined by several different procedures.

Inotropic and electrophysiologic effects of amrinone in untreated and digitalized ventricular tissues

The purposes of this study were to determine whether amrinone induces oscillatory afterpotentials (OAP) or aftercontractions (AC) in Purkinje tissue or myocardium, to determine whether a relationship exists between the production of OAP or AC and the inotropic effects of amrinone and to determine possible effects of amrinone on the oscillations and the positive inotropic effect produced by digitalis. Isolated canine papillary and trabecullar muscles, as well as false tendons, were exposed to 5.3 X 10(-4) M amrinone. Some of the preparations had been pretreated with acetylstrophanthidin (AS) in a dose just sufficient to induce OAP or AC. Standard electrophysiologic techniques were used to record transmembrane action potentials. Developed tension also was recorded. Amrinone by itself did not induce OAP or AC in myocardium or false tendons. This was true even when the resting membrane potential of the false tendons was reduced by means of focal current application. Amrinone increased the amplitude of AS-induced oscillations in both myocardium and false tendons. Amrinone increased strength of contraction of untreated myocardium at all basic cycle lengths and of AS-treated myocardium, especially at shorter basic cycle lengths. Amrinone decreased strength of contraction both of untreated and AS-treated false tendons at all basic cycle lengths. The results suggest that there may be important differences in the mechanisms of action of amrinone and digitalis.

Propranolol effects on membrane repolarization time in isolated canine Purkinje fibers: threshold tissue content and the influence of exposure time

This study has examined the relationship between the Purkinje fiber content of propranolol and effects on membrane repolarization time during prolonged exposure to low concentrations of propranolol in vitro. Canine Purkinje fibers were exposed to both dl-propranolol, 3.4 X 10(-7) M (0.1 microgram/ml) and 1.7 X 10(-6) M (0.5 micrograms/ml), and to d-propranolol, 3.4 X 10(-7) M (0.1 micrograms/ml), in Tyrode's solution for 90 to 180 min. Purkinje fibers exhibited continuous decreases in repolarization time throughout the exposure periods and fibers analyzed for propranolol content demonstrated continuous cumulation of the drug with time. A maximum 8% decrease in repolarization time was observed after 3.4 X 10(-7) M and a 30% decrease after 1.7 X 10(-6) M propranolol. A 40-fold cumulation of propranolol by the Purkinje fibers was found after both concentrations at or near equilibrium. A high degree of correlation (r = 0.98; P < .001) existed between changes in electrical activity and tissue content of propranolol. Extrapolation to zero effect showed a threshold tissue content of propranolol of approximately 1.0 microgram/g, which corresponds to a bath concentration of 25 ng/ml (8 X 10(-8) M). Changes in membrane potentials were the result of direct membrane effects of propranolol, based on the fact that d-propranolol produced membrane alterations and tissue cumulation identical to those produced by the racemic drug.

Diverse electrophysiologic effects of propafenone and flecainide in canine Purkinje fibers: implications for antiarrhythmic drug classification

Propafenone and flecainide are assigned to class Ic of the Campbell-Vaughan Williams classification because of their effects on ventricular muscle. The authors compared the use-dependent local anesthetic properties and the effects on repolarization of these drugs (1 and 5 microM) in Purkinje fibers. A reduction in maximum upstroke velocity was used as an index of the local anesthetic action. The rate dependency of the drug's effects on repolarization was evaluated by analyzing the relationship between action potential duration during steady-state stimulation and cycle length (CL). Tonic block was higher for propafenone (n = 10) than for flecainide (n = 7) at both concentrations tested (19 +/- 3% vs. 4 +/- 1% at 1 microM; 59 +/- 10% vs. 24 +/- 4% at 5 microM). Use-dependent block onset and dissipation were significantly slower for flecainide than for propafenone (e.g., at 1 microM and CL = 500 ms, time constant of block onset = 31 +/- 6 vs. 9 +/- 1 beats; time constant of recovery from block = 7.7 +/- 0.2 vs. 2.8 +/- 0.2 sec; P < .05). Steady-state block measured at each CL was compared with that predicted by a theoretical model of use dependency. Predictions approximated the experimentally results only for flecainide. At 1 microM, propafenone shortened action potential duration at all rates; flecainide had biphasic effects. At 5 microM, the effect of flecainide was similar to that of 1 microM propafenone. Thus, in Purkinje fibers, the kinetics of use-dependent local anesthetic effects and the effects on repolarization discriminate flecainide from propafenone.

Electrophysiological actions of Ro5-4864 on cerebellar Purkinje neurons: evidence for "peripheral" benzodiazepine receptor-mediated depression

The effects of Ro 5-4864 (4'-chlorodiazepam; the archetypic peripheral benzodiazepine receptor ligand) were examined on the electrophysiological responses of rat cerebellar Purkinje neurons maintained in vitro. Ro 5-4864 produced a biphasic response (consisting of an increase followed by a decrease in spontaneous firing) in approximately 50% of the neurons studied. The remaining neurons responded to Ro 5-4864 application with decreased spontaneous activity. The EC50 and IC50 values for the excitatory and depressant responses to Ro 5-4864 were 490 and 450 nM, respectively. Preincubation with PK 11195 [N-methyl-N-(methyl-1-propyl)chloro-2-phenyl-1-isoquinoline-3-carboxamid e; a peripheral benzodiazepine receptor antagonist] reduced the potency of Ro 5-4864 to inhibit cell firing in a competitive fashion, but did not alter Ro 5-4864-elicited excitations. A similar effect was observed with the monocarboxylic acid anion transport inhibitor UK 5099 [alpha-cyano-beta-(1-phenylindol-3-yl)acrylate]. In contrast, the increases in cell firing elicited by t-butylbicyclophosphorothionate (a GABA-gated chloride channel blocker) were enhanced 6-fold by coperfusion with both Ro 5-4864 and PK 11195. These findings suggest that the Ro 5-4864 induced depressions of Purkinje neuron spontaneous activity is mediated by peripheral benzodiazepine receptors, whereas the excitation may result from modulation of the gamma-aminobutyric acid-gated chloride ionophore.

Effects of lidocaine and on slow response and depressed fast response action potentials of canine cardiac Purkinje fibers

Disease may decrease resting potential of cardiac fibers, thereby depressing the upstroke velocity of the action potential, causing slow conduction and reentry. A decrease in resting potential may also cause automaticity. We studied the effects of lidocaine (5 and 20 mg/l) on canine Purkinje fibers with reduced membrane potentials with either depressed Na+-dependent upstrokes (depressed fast responses) or with slow inward (Ca++) current-dependent upstrokes (slow responses). Depressed fast responses were produced by elevating [K+]0 in the perfusate, reducing membrane potential to around -60 mV, without abolishing excitability. Slow responses were produced by either perfusing fibers with a Na+-free, Ca++-rich solution, or by perfusing them with a high [K+]0 Tyrode's solution containing norepinephrine. Lidocaine had a marked depressant effect on depressed fast response action potentials. The drug markedly decreased Vmax and conduction velocity. It sometimes decreased action potential amplitude and caused conduction block. Resting potential was not changed. On the other hand, lidocaine had little effect on slow response action potentials. Resting potential, Vmax and action potential amplitude were not altered nor was conduction changed. The rate of spontaneous impulse initiation was slightly reduced by 5 mg/l of lidocaine but not by 20 mg/l. We conclude that lidocaine does not exert its antiarrhythmic effect by directly depressing the slow inward current but may be antiarrhythmic because it depresses an already depressed fast inward current and can cause conduction block.