Effect of 4-aminopyridine on cardiovascular functions in the dog

T wave changes persisting after ventricular pacing in canine heart are altered by 4-aminopyridine but not by lidocaine. Implications with respect to phenomenon of cardiac 'memory'

BACKGROUND

Cardiac "memory" refers to changes in T wave polarity induced by ventricular pacing that persist long after resumption of normal atrioventricular conduction.

METHODS AND RESULTS

We studied the occurrence and mechanism of T wave changes in the open-chest anesthetized dog subjected to three discontinuous 20-minute periods of right ventricular pacing. ECG changes were recorded in the standard limb leads during normal conduction (prepacing) and three trains (T1, T2, and T3) of right ventricular pacing at a rate 50% higher than normal (pacing), each followed by a period of normal conduction (postpacing) lasting as long as necessary for T wave changes to return to control values. During each of these phases, heart rate, QRS, corrected QT (QTc) duration, and T wave amplitude were measured. In the first group (control), T wave inversions occurred during normal atrioventricular conduction after a period of right ventricular pacing. These T wave anomalies appeared in the absence of any change in heart rate, QRS, or QTc duration. The magnitude of the T wave amplitude change was significantly greater after each successive pacing period. Furthermore, the changes in T wave morphology persisted for a longer period after each successive pacing train. In a second experimental group, lidocaine, which depresses the sodium window current, was administered to six dogs that were subjected to the same pacing protocol. Lidocaine decreased the QTc interval and prolonged QRS duration but did not alter the magnitude of changes in T wave amplitude and time to recovery described in control animals during the three postpacing intervals. In contrast, in the third group, 4-aminopyridine, a drug that blocks the transient outward current (ito), abolished the changes in T wave morphology that occurred during any postpacing interval.

CONCLUSIONS

These results demonstrate that the manifestation of cardiac memory in the in situ dog heart is not altered by lidocaine but is abolished by 4-aminopyridine. Thus, cardiac memory may be based on a physiological property of the myocardium that is related to specific K+ channels.

The mode of action of 4-aminopyridine on the chronotropic and inotropic responses in the isolated, blood-perfused dog heart

The effects of 4-aminopyridine (4-AP, 0.3 to 300 micrograms) on atrial rate and atrial muscle contractile force were investigated in the isolated, blood-perfused dog atrial preparation. Low doses (less than 30 micrograms) of 4-AP injected into the sinus node artery caused a dose-dependent positive inotropic response and a negligible positive chronotropic response. A higher dose (300 micrograms) of 4-AP induced a transient positive chronotropic response followed by a negative response and positive and negative inotropic responses. The negative cardiac responses to 4-AP were completely inhibited by an adequate dose of atropine and were potentiated by physostigmine. TTX or C6 suppressed partly, but significantly the negative responses induced by 4-AP. On the other hand, the negative responses to electrical stimulation (ES) were inhibited by atropine, C6 and TTX and those to ACh were blocked by atropine but not by C6 or TTX. The positive responses to 4-AP were not affected by propranolol but were potentiated by atropine. The positive inotropic response to 4-AP was significantly suppressed by a calcium channel blocker, diltiazem. From these results, it is concluded that the cardiac responses to 4-AP are composed of direct positive responses and negative responses which are related to activation of parasympathetic ganglionic neurotransmission.

Antagonism of d-tubocurarine-induced neuromuscular blockade with a mixture of 4-aminopyridine and neostigmine in man

The antagonistic properties of a mixture of 4-aminopyridine (4-AP) 3 mg X ml-1 and neostigmine 0.2 mg X ml-1 (in three patient groups) administered at 90 per cent d-tubocurarine block were compared with those of plain neostigmine (in three patient groups) in thirty-six patients during thiopentone-fentanyl-nitrous oxide-oxygen anaesthesia. The recovery variables included thumb twitch height, thenar e.m.g. peak-to-peak amplitude, and train-of-four ratio in response to supramaximal ulnar nerve stimulation. In addition, mean arterial pressure, heart rate, apnoea time and time to responsiveness to verbal command after nitrous oxide was turned off at 20 minutes of recovery were examined as circulatory and central nervous system responses to antagonism. The addition of 4-AP 30 mg to neostigmine 2 mg enhanced the recovery of train-of-four ratio from 54.2 +/- 5.2 to 80.2 +/- 5.2 per cent at 20 mins of antagonism (mean +/- SEM; p less than 0.01) while adding 4-AP 45 mg to neostigmine 3 mg increased the train-of-four ratio from 67.7 +/- 2.3 to 92.3 +/- 2.4 per cent (p less than 0.01) when compared with plain neostigmine. No statistically significant difference could be found between the groups in the recovery of twitch height or e.m.g. amplitude. The antagonism of d-tubocurarine block with 4-AP 30 mg plus neostigmine 2 mg was at least as effective as with neostigmine 3-4 mg. Mean arterial pressure increased in the group receiving 45 mg 4-AP plus 3 mg neostigmine.(ABSTRACT TRUNCATED AT 250 WORDS)