Comparison of the electrophysiological effects of two neuroleptics, melperone and thioridazine, on isolated rat atria

Prolonged action potential duration of guinea-pig heart muscle after pethidine

Since recent experiments indicated class III antiarrhythmic properties of pethidine in vitro, we studied cardiac effects of pethidine in vivo. Monophasic action potentials at different pacing rates were recorded from the left ventricular epicardium of pentobarbital anaesthetized guinea-pigs by means of suction electrode catheter. Intravenous injection of pethidine 2 mg/kg prolonged the action potential duration, and increased left ventricular developed pressure and dP/dt max, compared to animals receiving saline only. It is concluded that pethidine appears to have class III antiarrhythmic properties.

Class III antiarrhythmic action linked with positive inotropy: acute electrophysiological and inotropic effects of amiodarone in vitro

Negative inotropy is an adverse feature of most antiarrhythmic drugs. Positive inotropy, however, has been demonstrated for some drugs with class III antiarrhythmic action. Although amiodarone exerts its antiarrhythmic effect by an interplay of different actions on cardiac cells, it has been regarded to be the prototype class III drug due to its prolongation of action potential duration. The present study was designed to test the hypothesis that class III antiarrhythmic action and positive inotropy may be linked. We compared the effects of amiodarone in Cordarone and its solvent Tween 80 on automaticity, refractoriness and inotropy. Two series of experiments were done; one with spontaneously beating rat atria to study the effects on sinus node function, and one with electrically stimulated left atria to study the effects on excitability, refractoriness and inotropy. Amiodarone 1 x 10(-4) M decreased spontaneous heart rate by 13% and prolonged sinus node recovery time by 105%. Without affecting the excitability amiodarone prolonged the effective refractory period by 12%. At the same time contractile force increased by 12%. Lower concentration of amiodarone (5 x 10(-6) M) or Tween 80 had no significant effects. In conclusion, amiodarone exerts acute electrophysiological and inotropic effects in vitro. The class III antiarrhythmic action of amiodarone is linked with positive inotropy.

Function of myocardial alpha-adrenoceptors

In addition to beta-adrenoceptors (beta ARs), cardiac myocytes of animals and man possess alpha 1ARs, but not alpha 2ARs. Norepinephrine and epinephrine have a higher affinity for myocardial alpha 1ARs than for beta ARs. Unlike beta AR stimulation, myocardial alpha 1AR stimulation does not increase the slow inward current. The alpha 1AR-mediated positive inotropic effect seen in isolated heart preparations appears to involve increased Ca sensitivity of myofibrils and production of inositol triphosphate (IP3) and diacylglycerol (DAG), but the functions of IP3 and DAG are not clear. Myocardial alpha 1AR stimulation reduces rate of isolated atria and Purkinje fibers and lengthens refractory period and action potential duration. Hypoxia increases alpha 1AR density in cardiomyocytes. alpha 1AR-mediated arrhythmias occur in isolated Purkinje fibers during hypoxia, following infarction, and in the presence of Ba2+ or high Ca2+. In animals, coronary artery occlusion and/or reperfusion increase myocardial alpha 1AR density and responsiveness, and alpha AR blocking drugs attenuate arrhythmias. However, an antiarrhythmic effect of alpha AR blocking drugs mediated by action on coronary vascular alpha ARs cannot be excluded. Presently available drugs do not differentiate between myocardial and vascular alpha ARs and thus affect the coronary and systemic circulations and, indirectly, the heart. Additional myocardial alpha 1AR-mediated effects include production of cardiac hypertrophy, stimulation of glucose uptake and phosphofructokinase and cyclic AMP phosphodiesterase activity, and release of atrial natriuretic peptide.

Class III antiarrhythmic action linked with positive inotropy: effects of the d- and l-isomer of sotalol on isolated rat atria at threshold and suprathreshold stimulation

The beta-adrenoceptor blocker sotalol has been shown to possess class III antiarrhythmic action. The present study was designed to test the hypothesis that class III antiarrhythmic action and positive inotropy may be linked. Since d,l-sotalol has previously been reported to have variable inotropic effect, we studied direct effects of the d- and l-stereoisomer of sotalol on refractoriness and inotropy of isolated rat atria at different strengths of electrical stimulation. Both the d- and l-stereoisomer of sotalol (7.5 x 10(-5) M) increased the effective refractory period, and to the same extent. However, d-sotalol increased isometric contractile force by 10%, while l-sotalol had no significant effect, when the atria were stimulated at close to threshold values (10 +/- 1 mA). Probably due to release of noradrenaline within the myocardium, contractile force increased when the atria were stimulated at suprathreshold values (40 mA). At suprathreshold stimulation, however, d-sotalol induced a 10% decrease and l-sotalol a 20% decrease, in contractile force. In conclusion, the class III antiarrhythmic action of sotalol is linked with positive inotropy. In the presence of neurotransmitter release, negative inotropic effect of d- and in particular l-sotalol, may occur due to beta-adrenoceptor blocking activity.

Comparison of electrophysiological and mechanical effects of droxicainide and lidocaine on heart muscle isolated from rats

A new antiarrhythmic drug, droxicainide, was compared with lidocaine in order to evaluate droxicainide's effect on heart muscle. Dose-response curves for electrophysiological and mechanical effects of the two drugs on spontaneously beating atria, electrically stimulated atria and papillary muscles isolated from rats were obtained. After increasing doses of both droxicainide and lidocaine sinus node automaticity decreased, atrial and ventricular excitability and contractile force decreased and refractoriness increased. The effects of the two drugs on atrial and ventricular muscle were qualitatively and quantitatively the same, but droxicainide was less potent. The results fit well with the concept that droxicainide is a class 1 anti-arrhythmic drug.

Thioridazine-5-sulfoxide cardiotoxicity in the isolated, perfused rat heart

The potential cardiotoxicity of a racemic mixture of thioridazine-5-sulfoxide, an oxidative metabolite of thioridazine, was studied in the isolated, perfused rat heart. Thioridazine-5-sulfoxide (ring sulfoxide) was prepared by a new method in which a racemic mixture of the two diastereoisomeric forms of the compound was formed. Hearts from male Sprague-Dawley rats were perfused using a modified Langendorff preparation. Quinidine (31 microM) served as a positive control for the measurements of the electrocardiogram (ECG) and the heart rate. Thioridazine (13 microM) perfusion resulted in a variable heart rate and elevated S-T segment. Perfusate concentrations of the ring sulfoxide as low as 12 microM increased P-R and Q-T intervals, produced delays in A-V and ventricular conduction, premature ventricular contractions and ultimately A-V block. These findings suggest that thioridazine cardiotoxicity may be due in part to the actions of thioridazine ring sulfoxide.

A method for simultaneous epicardial monophasic action potential recordings from the dog heart in situ

In order to record epicardial monophasic action potentials (MAP) simultaneously from different regions of intact beating hearts, we developed a tripodal suction electrode device (total weight 1.5 g, distance between the flexible silicone legs 25 mm) which we tested in pentobarbital anaesthetized open chest dogs. The device was easy to apply and gave stable and reproducible recordings. Repolarization times for epicardial left ventricular and endocardial right ventricular MAPs correlated well (r = 0.97, P less than 0.001). There was no correlation between MAP amplitude and repolarization times. The beta 1-adrenergic agonist prenalterol decreased MAP duration, while the new class III antiarrhythmic drug melperone increased MAP duration. Mild ischaemia effected MAP prolongation and severe ischaemia MAP shortening, compared to simultaneous recordings from non-ischaemic ventricular regions. We conclude that the new tripodal suction electrode is a simple device for simultaneous recording of multiple MAPs. The method should be suitable for studies of electrophysiological effects of drugs and other interventions in intact beating hearts.

Plasma levels and cardiac electrophysiological effects of melperone in the dog

The butyrophenone neuroleptic melperone has recently been shown to possess antiarrhythmic properties in man and animals. We studied the correlation between plasma concentration of melperone and the electrophysiological and blood pressure effects of the drug in 20 pentobarbital-anaesthetized dogs. Linear correlations were found between the log melperone plasma concentration and decreases in mean aortic blood pressure and heart rate, and increases in atrial and AV nodal refractoriness. The correlations were better after pretreatment with the beta 1-blocker atenolol. There was a linear correlation between log melperone plasma concentration and increases in ventricular refractoriness only after atenolol. No correlation was found between log melperone plasma concentration and decreases in AV nodal conduction time. Apart from the effect on AV nodal conduction time, the relationship between plasma concentration of melperone and the electrophysiological and blood pressure effects after beta 1-blockade fits well into an overall log concentration-effect relationship. The poorer correlation without beta 1-blockade was probably due to a combination of direct and indirect effects of the drug.

Electrophysiological and mechanical effects of sulphinpyrazone on isolated rat atria

Clinical trials suggest that sulphinpyrazone reduces the incidence of sudden death in patients having suffered a myocardial infarction. To investigate possible direct antiarrhythmic properties of sulphinpyrazone, we carried out experiments on spontaneously beating and electrically stimulated isolated rat atrial preparations. Dose-response curves for electrophysiological and mechanical effects of sulphinpyrazone were obtained. Increasing doses of sulphinpyrazone decreased the spontaneous atrial frequency, prolonged the sinus node recovery time after overdrive pacing, slightly increased the electrical threshold for excitation and decreased the contractile force. Although the mechanism by which sulphinpyrazone may reduce the incidence of sudden cardiac death is still not settled, the present study demonstrates direct electrophysiological and mechanical effects of the drug at high concentrations.

The mode of antiarrhythmic action of melperone

We studied the mode of antiarrhythmic action of melperone by His bundle electrography combined with programmed electrical stimulation in 21 pentobarbital anaesthetized dogs. Melperone alone (0.5 to 12.5 mg/kg) as well as melperone after sympathetic and parasympathetic blockade caused a dose-dependent increase in the ventricular and, even more, the atrial effective refractory period without affecting atrial and ventricular conduction times. Melperone shortened the atrioventricular nodal conduction time regardless of sympathetic and parasympathetic blockade. We conclude that the antiarrhythmic effect of melperone in most likely primarily due to a direct class III antiarrhythmic action.

Differential actions on rabbit nodal, atrial, Purkinje cell and ventricular potentials of melperone, a bradycardic agent delaying repolarization: effects of hypoxia

1 Melperone, a butyrophenone tranquillizer, caused bradycardia in vivo and in vitro. 2 Although Melperone had alpha-adrenoceptor antagonist activity in the pithed rat, it was not a beta-adrenoceptor antagonist, nor was it a cholinoceptor agonist. 3 The bradycardic action could be attributed almost entirely to a prolongation by Melperone of action potential duration (APD) in sinus node cells, with little effect on the slow diastolic depolarization. 4 APD was prolonged by Melperone in atrial and ventricular muscle, and most of all in the bundle of His, but only moderately in the terminal Purkinje cells. 5 In all cardiac tissues depolarized by fast inward current. Melperone caused a dose-related reduction in the maximum rate of depolarization and conduction velocity. On desheathed frog nerve Melperone had a local anaesthetic potency equal to that of procaine. 6 There was no negative inotropic effect in cardiac muscle, nor interference with A-V nodal conduction, from which it was inferred that Melperone did not restrict slow inward current. 7 Melperone did not reduce hypoxic shortening of APD relative to the initial value at the start of hypoxia, but because APD was already lengthened by Melperone in normoxic conditions, APD90 during hypoxia remained close to normal values. There was no protection against hypoxic depression of contractions. 8 It was concluded that Melperone had class 1 and class 3 antiarrythmic actions and merited trial as an antiarrhythmic drug.

Effect of intravenous melperone on atrial repolarization in man

The effect of 10 mg of melperone intravenously on the duration of the right atrial monophasic action potential was studied in seven patients and one healthy volunteer. Melperone induced an increase of the atrial monophasic action potential duration by 13%, 15 min after intravenous injection of the drug. This prolongation was a consistent finding but was within the limits of normal intra-individual variation and considerably smaller than normal inter-individual differences. However, the observations warrant studies to evaluate the effect of the drug in different cardiac arrhythmias.

Classification of cardioactive drugs in vivo by using programmed electrical stimulation in combination with monophasic action potential recordings at different pacing rates

The effect of antiarrhythmic drugs on myocardial refractoriness may be due to changes either in Vmax of phase 0 or the phase of repolarization of the AP or both. By using programmed electrical stimulation in combination with MAP recordings at different pacing rates in the intact dog heart, it was possible to classify and to a certain extent to elucidate the mode of action of various cardioactive drugs in vivo.

Electrophysiological effects of bunaphtine on isolated rat atria

The effects of a new antiarrhythmic, bunaphtine, on the electrical and mechanical activity of isolated rat atria were compared with those of quinidine and amiodarone. Both electrically stimulated and spontaneously beating atria were used. In spontaneously beating double atria bunaphtine produced a dose-dependent decrease in the rate, contractile force, work index and maximum following frequency at which the atria could respond to electrical stimulation, depressed the pacemaker activity and increased the sinus node recovery time. In isolated left atria bunaphtine prolonged the effective refractory period and decreased atrial excitability. Bunaphtine did not block positive chronotropic and inotropic responses to isoprenaline and did not reduce the positive inotropic effect of raised calcium concentrations. These results support the hypothesis that bunaphtine exerted on isolated atria a direct cardiodepressant effect similar to that of quinidine, and that it may be classified as a class 1 antiarrhythmic according to the classification of Vaughan Williams.