Effects of quinidine on action potentials and ionic currents in isolated canine ventricular myocytes

We examined the effects of quinidine (5-20 microM) on transmembrane action potentials and ionic currents of isolated canine ventricular myocytes. Collagenase treatment of canine ventricular tissue produced a yield of 40-60% healthy cells. Myocytes had normal resting and action potentials as measured using conventional microelectrodes. Quinidine decreased Vmax, amplitude, overshoot, and the duration of action potentials stimulated by passage of brief current pulses through the recording pipette. Recovery was complete after washout except that action potential duration was prolonged compared with control. A discontinuous single microelectrode voltage ("switch") clamp was used to measure ionic currents. Quinidine irreversibly reduced steady-state outward current as measured with three different voltage clamp protocols. Quinidine reversibly decreased peak calcium current as well as the slowly inactivating and/or steady-state inward currents in the plateau voltage range, presumably both "late" sodium (tetrodotoxin-sensitive) and calcium (tetrodotoxin-insensitive) currents. The effect on calcium current showed both tonic and use-dependent block. Thus, quinidine has a multitude of actions on both inward and outward currents, which combine to produce the net effect of quinidine on action potential configuration.

Evidence that uncharged verapamil inhibits myocardial contractility

The object of this study was to determine the molecular species of verapamil (Vp) which is responsible for the negative inotropic activity of the drug. Toward this end, we developed a model system which allowed us to determine the concentrations of protonated and neutral Vp and four congeners in solution and bound to an amphiphilic interface. We then determined the effect of Vp and these congeners on twitch tension in sheep trabecular muscle and correlated species abundance with biologic activity. The cumulative log dose-response curves of Vp, acyano-Vp and nor-Vp were sigmoidal. The concentrations of drug which were required to inhibit twitch tension by 50% (IC50) were 1000 +/- 240, 3350 +/- 620 and 7140 +/- 950 nM, respectively (mean +/- S.D.; P less than .01). Quaternary-Vp, an amphiphilic, nonionizable protonated derivative, produced some nonspecific inhibition which never reached 50%. Tetrahydroxy-Vp, a hydrophilic ionizable derivative, was inactive. Concentrations of the membrane-bound, neutral form of Vp, acyano-Vp and nor-Vp were comparable at their IC50 values (86 +/- 19, 104 +/- 19 and 121 +/- 16 nM, respectively; mean +/- S.D.; P, N.S.). In contrast, the concentrations of the membrane-bound, protonated form were significantly different and accounted for the "apparent" difference in the IC50 values. Based on these data, we conclude that: 1) ionizability and amphiphilicity are required for the negative inotropic effects of verapamil, acyano-Vp and nor-Vp; 2) twitch tension correlates best with the concentration of the membrane-bound neutral form of each drug; and 3) the potency differences between Vp, acyano-Vp and nor-Vp, as reflected by their IC50 values, are apparent, not real.

A matrical approach to the basic and clinical pharmacology of antiarrhythmic drugs

In summary, the lethal cardiac arrhythmias remain a major public health problem and their treatment is a major challenge to the clinician. We possess rapidly increasing knowledge of the electrophysiologic events which underly arrhythmogenesis and the antiarrhythmic as well as the proarrhythmic actions of drugs. Much of this electrophysiologic knowledge is irrelevant to the practicing physician. While complex, we believe that the matrical approach provides the clinician with a useful intellectual framework within which to consider the actions of arrhythmogenic influences and antiarrhythmic drugs. The matrical approach is scientifically sound, reflects clinical realities, and serves as a rational guide to the treatment of cardiac arrhythmias. The traditional classifications of antiarrhythmic drugs have served a useful purpose, but they are clearly outmoded.

Effect of prolonged depolarizations on twitch tension and intracellular sodium activity in sheep cardiac Purkinje fibres

1. Twitch tension and intracellular Na+ activity (aiNa) were measured in voltage-clamped sheep cardiac Purkinje fibres. aiNa was measured using Na+-sensitive micro-electrodes filled with the liquid ion exchange resin. ETH 227. The stimulus for contraction was a constant 200 ms depolarizing pulse to 0 mV from a holding potential of -80 mV delivered at 0.25 Hz. Prolonged test pulses for 1.8 s (post-pulses) were applied at the end of the stimulus pulse. The effects of post-pulses on twitch tension and aiNa were examined. 2. Post-pulses in the range of -40 mV reduced twitch tension below control force produced without post-pulse. Progressively more positive post-pulses to levels above 0 mV profoundly increased twitch tension, with a greater than 400% rise in tension at +50 to +60 mV compared to control tension. aiNa declined at positive post-pulse potentials by more than 2 mM at +30 to +40 mV. 3. Tetrodotoxin (100 microM) did not affect the post-pulse voltage-tension or voltage-aiNa relation. Ca2+ channel modulation with nitrendipine (1 microM) similarly did not alter the post-pulse voltage-tension relation. 4. Removal of extracellular Na+ eliminated the nadir in tension at post-pulses to -40 mV and the augmentation of tension at post-pulses above 0 mV. 5. We interpret these findings as evidence of voltage-sensitive Na-Ca exchange promoting net Ca2+ influx and net Na+ efflux during positive post-pulses. The unusual shape of the post-pulse voltage-tension relation curve can be accounted for by a charged-carrier model of electrogenic Na-Ca exchange. The inverse relation between aiNa and twitch tension probably reflects the combined effects of reduced aiNa leak and changes in Na+ and Ca2+ flux via voltage-sensitive Na-Ca exchange.

Depolarizing effects of catecholamines in quiescent sheep cardiac Purkinje fibers

Isoproterenol reversibly depolarizes quiescent sheep cardiac Purkinje fibers, in contrast to its reported hyperpolarizing effect in many excitable tissues. The depolarization is inhibited by drugs that block beta 1-adrenergic receptors. Tetrodotoxin and verapamil have no effect on the isoproterenol-induced depolarization. Cesium reduced the isoproterenol-induced depolarization by 74%. The voltage dependency of activation of a current component called If, measured under voltage clamp, was shifted in the depolarizing direction by isoproterenol. No evidence was found to support the suggestion made for other tissues that the Na+-K+ pump is stimulated by isoproterenol. These data suggest that in quiescent sheep Purkinje fibers the isoproterenol-induced depolarization reflects activation of a pacemaker current.

Effects of MDL 19205 (piroximone), a new cardiotonic agent, on electrophysiological, mechanical, and intracellular ionic characteristics of sheep cardiac tissues

This study was undertaken to characterize the cardiac electrophysiological and mechanical effects of MDL 19205, a new and potent nonglycoside, positive inotropic agent. In addition, intracellular Na+ activity (aiNa) was measured to determine if this agent might produce its inotropic effects by increasing aiNa and secondarily by increasing intracellular calcium via Na+ -Ca2+ exchange. Experiments were conducted in free-running trabecular muscles and Purkinje fibers obtained from sheep hearts. The following were the most significant effects of MDL 19205: a decrease in action potential duration in both ventricular and Purkinje tissues; a cumulative dose-dependent increase in contractile force in ventricular muscle but not in Purkinje strands; no change in aiNa in Purkinje fibers to accompany the positive inotropic effect of this agent; a shift in the dose-response relation by approximately fourfold in the presence of beta-adrenergic blockade with sotalol (10(-7) M); an enhancement of diastolic depolarization in Purkinje fibers resulting in automaticity that is accelerated by overdrive; and a potentiation of the positive inotropic effects of MDL 19205 by 8-bromo-cAMP (1 mM), indicating a potent phosphodiesterase inhibitory action of MDL 19205. These results suggest that MDL 19205 exerts at least part of its positive inotropic and automatic actions through stimulation of beta-adrenergic receptors. This action occurs in conjunction with its ability to inhibit phosphodiesterase, thus promoting an accumulation of cAMP in cardiac cells. Other intracellular actions may also contribute to the effect of this drug, but they do not rely on an increase in aiNa or dramatic changes in the action potential plateau or duration.

Intracellular sodium and the positive inotropic effect of veratridine and cardiac glycoside in sheep Purkinje fibers

Veratridine is a sodium channel toxin that exerts a powerful positive inotropic effect and prolongs the action potential duration in the heart. To determine the basis of the inotropic action of veratridine and to examine the effects of dissimilar methods of raising intracellular sodium activity on contractility, we measured twitch tension and intracellular sodium activity using sodium-sensitive microelectrodes in stimulated sheep Purkinje fibers exposed to veratridine and in voltage-clamped fibers exposed to veratridine and cardiac glycoside. In stimulated fibers, veratridine (0.1-1 microM) produced coincident increases in intracellular sodium activity, action potential duration, and tension. In voltage-clamped fibers, veratridine (1-2 microM) and acetylstrophanthidin (0.1 microM) raised intracellular sodium activity and tension to a comparable degree. Tetrodotoxin (10 microM) abolished the mechanical, electrophysiological, and ionic changes produced by veratridine. The relationship between intracellular sodium activity and tension in voltage-clamped fibers (n = 6) was indistinguishable for veratridine and acetylstrophanthidin and could be fitted either with a linear function with slopes of 122.8% and 124.2%, respectively, or with a power function with slopes of 4.60 and 4.54, respectively, where the slope represents the exponential power of intracellular sodium activity to which tension is proportional. These results indicate that the positive inotropic action of veratridine is entirely accounted for by accumulation of intracellular sodium, which increases intracellular calcium available for contraction by sodium-calcium exchange. This study is the first direct demonstration that veratridine or any other sodium channel toxin affects intracellular sodium activity and suggests that the inotropic potency of veratridine and cardiac glycoside rely on the same mechanism, namely, elevation of intracellular sodium.

Saxitoxin binding and "fast" sodium channel inhibition in sheep heart plasma membrane

We compared specific [3H]saxitoxin (STX) binding to isolated sheep ventricular sarcolemmal vesicles with inhibition of maximal action potential upstroke velocity (V max) by STX and tetrodotoxin (TTX) in sheep trabeculae carneae. In sarcolemmal vesicles purified 30 to 40 times over cardiac homogenate, STX binding at 0 degrees C in Na-free solution exhibited both high-affinity sites (KD = 0.22 +/- 0.05 nM, n = 85 +/- 13 fmol/mg protein) and low-affinity sites (KD = 11 +/- 4 nM, n = 360 +/- 42). The STX-inhibition constant for V max in Tyrode solution at 37 degrees C was 280 nM. TTX was approximately 10% as effective as STX in displacing bound [3H]STX and inhibiting V max. Allowing for different experimental conditions during [3H]STX binding and V max measurements, we suggest that the low-affinity sites are physiologically relevant "fast" Na+ channels of myocardial cells. Combining morphometric data for plasmalemmal area of mammalian cardiac myocytes with n for low-affinity sites, we estimate 3.6-7.6 fast Na+ channels/micron2 plasmalemma.

Relation between intracellular sodium and twitch tension in sheep cardiac Purkinje strands exposed to cardiac glycosides

Changes in intracellular sodium ion activity (aiNa) produced by several cardiac glycosides were correlated with twitch tension in sheep cardiac Purkinje strands. Simultaneous measurements of aiNa and twitch tension were obtained through the use of Na-sensitive intracellular microelectrodes (ETH 227) in Purkinje preparations stimulated at a frequency of 1 Hz. All concentrations of ouabain, acetylstrophanthidin, and actodigin that were tested caused an increase in aiNa immediately before, or coincident with, a positive inotropic effect. No fall in aiNa was observed at any positive inotropic concentration of digitalis in these beating fibers. In all cases, the onset and washout of the positive inotropic effect were paralleled by the rise and fall in aiNa, respectively. No dissociation between changes in aiNa and twitch tension occurred at any concentration of any of the agents used. The relation between changes in aiNa and twitch tension was linear with 1 mM increase in aiNa producing about a 100% increase in the twitch magnitude. Propranolol did not significantly alter this relationship. The increase in aiNa with digitalis was also associated with a reduction in the maximum depolarization rate of the action potential, presumably as a consequence of a reduction in the transmembrane Na electrochemical gradient. These results indicate that the positive inotropic action of digitalis in sheep Purkinje strands is always associated with a rise in aiNa secondary to inhibition of the Na pump. This increase in aiNa could increase calcium available for contraction via the Na-Ca equilibrium exchange process. In addition, the increase in aiNa reduces Vmax, as a consequence of decreasing the electrochemical gradient for Na.

Dantrolene sodium: effects on isolated cardiac tissues

The effects of dantrolene sodium on dog Purkinje fibers, cat atrial and ventricular muscles were studied. Action potential duration was significantly increased and contractility was significantly decreased by dantrolene in all three types of tissue. The plateau phase of Purkinje fiber and occasionally atrial action potential was slightly depressed. Dantrolene sodium had no significant effect on resting membrane potential, action potential amplitude or upstroke velocity of phase 6. The negative inotropic effects were most pronounced in Purkinje fibers, followed by atrial muscle while papillary muscles were least sensitive. Contractile force of Purkinje fibers was decreased by relatively the same amount at all frequencies of stimulation. At faster rates, atrial and ventricular muscle contractility was depressed relatively more than at slower rates. Slow response action potentials in cat papillary muscle were diminished slightly, but this effect was not significant. All drug effects took 10 to 15 min to develop, reached a steady state after 30 to 40 min, and were irreversible upon washout. Increasing the extracellular calcium concentration reversed the dantrolene-induced changes. These findings suggest that effects of dantrolene are mediated in part by a decrease in the intracellular free calcium concentration in cardiac tissue.

Catecholamine effects on intracellular sodium activity and tension in dog heart

Because catecholamines have been reported to stimulate the sodium pump and Na+-K+-ATPase in skeletal and cardiac muscle, we examined the effects of isoproterenol (0.2-1.0 X 10(-6) M) and norepinephrine (2-4 X 10(-7) M) on intracellular sodium activity (aiNa) and twitch tension in dog Purkinje strands and ventricular muscles, aiNa was measured with Na+-sensitive microelectrodes. During the initial rapid increase in tension induced by catecholamines in Purkinje strands, no changes in aiNa were found. After 5-10 min aiNa decreased by about 2 mM, coincident with a small decline in twitch tension. When the catecholamine was removed, tension declined rapidly to a level less than control. Recovery of tension to its control level less than control. Recovery of tension to its control level occurred simultaneously with recovery of aiNa. Comparable changes in aiNa occurred in ventricular muscle, but the biphasic effect of catecholamines on tension was not seen. These results are consistent with sodium pump stimulation in cardiac muscle. In Purkinje strands the resulting changes in aiNa may alter the direct positive inotropic effect of catecholamines, probably by influencing Na+-Ca2+ exchange.

Voltage dependence of digitalis afterpotentials, aftercontractions, and inotropy

The effects of membrane potential on digitalis-induced oscillatory afterpotentials (OAP) and aftercontractions (AC) were investigated in isolated canine false tendons and canine and feline papillary muscles. Transmembrane potential and contractions were measured simultaneously. Membrane potential was varied by current applied through an extracellular pipet. The amplitudes of OAP and AC induced by acetylstrophanthidin (0.5-1.0 X 10(-7) g/ml) or actodigin (0.5-1.0 X 10(-6) g/ml) were increased by depolarization and decreased or abolished by hyperpolarization in all tissues. Prior to the appearance of OAP and AC in preparations exposed to the drugs, depolarization caused both phenomena to appear. As in muscle, the strength of beats superimposed on the ascending limb of AC was potentiated, and the strength of beats superimposed on the relaxation phase was depotentiated. When the amplitude of AC was decreased by hyperpolarization, both potentiation and depotentiation were diminished. This effect was accompanied by a partial reversal of the changes induced by acetylstrophanthidin in the course of restitution of contractility and the configuration of the force-frequency relation.