Electrically induced automaticity in ventricular myocardium

Depolarization-induced automaticity in rat ventricular cardiomyocytes is based on the gating properties of L-type calcium and slow Kv channels

Depolarization-induced automaticity (DIA) of cardiomyocytes is the property of those cells to generate pacemaker cell-like spontaneous electrical activity when subjected to a depolarizing current. This property provides a candidate mechanism for generation of pathogenic ectopy in cardiac tissue. The purpose of this study was to determine the biophysical mechanism of DIA in terms of the ion conductance properties of the cardiomyocyte membrane. First, we determined, by use of the conventional whole-cell patch-clamp technique, the membrane conductance and DIA properties of ventricular cardiomyocytes isolated from adult rat heart. Second, we reproduced and analysed DIA properties by using an adapted version of the experimentally based mathematical cardiomyocyte model of Pandit et al. (Biophys J 81:3029-3051 2001, Biophys J 84:832-841 2003) and Padmala and Demir (J Cardiovasc Electrophysiol 14:990-995 2003). DIA in 23 rat cardiomyocytes was a damped membrane potential oscillation with a variable number of action potentials and/or waves, depending on the strength of the depolarizing current and the particular cell. The adapted model was used to reconstruct the DIA properties of a particular cardiomyocyte from its whole-cell voltage-clamp currents. The main currents involved in DIA were an L-type calcium current (I CaL) and a slowly activating and inactivating Kv current (I ss), with linear (I B) and inward rectifier (I K1) currents acting as background currents and I Na and I t as modulators. Essential for DIA is a sufficiently large window current of a slowly inactivating I CaL combined with a critically sized repolarizing current I ss. Slow inactivation of I ss makes DIA transient. In conclusion, we established a membrane mechanism of DIA primarily based on I CaL, I ss and inward rectifier properties; this may be helpful in understanding cardiac ectopy and its treatment.

Modulation of spiral-wave dynamics and spontaneous activity in a fibroblast/myocyte heterocellular tissue--a computational study

Fibroblasts make for the most common nonmyocyte cells in the human heart and are known to play a role in structural remodeling caused by aging and various pathological states, which can eventually lead to cardiac arrhythmias and fibrillation. Gap junction formed between fibroblasts and myocytes have been recently described and were shown to alter the cardiac electrical parameters, such as action potential duration and conduction velocity, in various manners. In this study, we employed computational modeling to examine the effects of fibroblast-myocyte coupling and ratio on automaticity and electrical wave conduction during reentrant activity, with specific emphasis on dynamic phenomena and stability. Our results show that fibroblast density and coupling impact wave frequency in a biphasic way, first increasing wave frequency and then decreasing it. This can be explained by the dual role of the fibroblast cell as a current sink or a current source, depending on the coupled myocytes intracellular potential. We have also demonstrated that wave stability as manifested by the spiral-wave tip velocity and reentrant activity lifespan depends on fibroblast-myocyte coupling and ratio in a complex way. Finally, our study describes the required conditions in which spontaneous activity can occur, as a result of the fibroblasts depolarizing the myocytes' resting potential sufficiently to induce rhythmic pulses without any stimulation applied.

Electrophysiological mechanisms for ventricular arrhythmias in patients with myocardial ischemia: anesthesiologic considerations, Pt II

This is the second half of a two-part review article that discusses ventricular tachyarrhythmias, either induced by acute ischemia or consequent to chronic myocardial ischemia, and their anesthestic implications. The first half of the article was published in the June 1997 Issue of The Journal.

Role of the Inward K Rectifier in the Repetitive Activity at the Depolarized Level in Single Ventricular Myocytes

The role of the inward K(+) rectifier in the repetitive activity at depolarized levels was studied in guinea pig single ventricular myocytes by voltage- and current-clamp methods. In action potentials arrested at the plateau by a depolarizing current, small superimposed hyperpolarizing currents caused much larger voltage displacements than at the resting potential and sometimes induced a regenerative repolarization. Around -20 mV, sub- and suprathreshold repetitive inward currents were found. In the same voltage range, small hyperpolarizing currents reversed their polarity. During depolarizing voltage-clamp ramps, around -20 mV there was a sudden decrease in the outward current (I(ns): current underlying the negative slope in the inward K(+) rectifier steady state I-V relation). During repolarizing ramps, the reincrease in outward current was smaller and slower. During depolarizing and repolarizing current ramps, sudden voltage displacements showed a similar asymmetry. Repetitive I(ns) could continue as long as the potential was kept at the level at which they appeared. Depolarizing voltage-clamp steps also caused repetitive I(ns) and depolarizing current steps induced repetitive slow responses. Cadmium and verapamil reduced I(ns) amplitude during the depolarizing ramp. BRL 34915 (cromakalim), an opener of the ATP-sensitive K(+) channel, eliminated the negative slope and I(ns), whereas barium increased I(ns) frequency (an effect abolished by adding BRL). Depolarization-induced slow responses persisted in an NaCl- Ca-free solution. Thus, the mechanism of repetitive activity at the depolarized level appears to be related to the presence of the negative slope in the inward K(+) rectifier I-V relation. Copyright 1994 S. Karger AG, Basel

Facilitation of beta-adrenoceptor-mediated slow channel responses by hypoxia in guinea pig ventricular myocardium

The effects of hypoxia on the beta-adrenoceptor-mediated slow channel responses of guinea pig ventricular muscle in a potassium-rich (27 mM) solution containing Ba2+ were examined using microelectrode techniques. Isoproterenol produced a small depolarization of the resting membrane and also induced repetitive discharges of action potentials at higher concentrations, mainly due to a beta-adrenoceptor-mediated increase in the slow channel conductance. Two different threshold concentrations of isoproterenol, one for inducing depolarization and one for inducing automatic activity, were measured to assess myocardial responsiveness to catecholamines. During hypoxia, the electrically triggered slow upstroke action potentials of muscle were gradually depressed and catecholamine-induced membrane responses mediated by the beta-adrenoceptor/slow channel system were enhanced. The enhancement of the catecholamine effects was accelerated by acidosis and reversed by reoxygenation. Methyl xanthine-induced responses, similar to those induced by catecholamines, were also enhanced during hypoxia. It is suggested that not only changes of catecholamine-beta-adrenoceptor interaction, but also changes of intracellular metabolic processes, may be responsible, at least in part, for the enhancement of abnormal automatic activity mediated by the myocardial beta-adrenoceptor/slow channel system under hypoxic conditions.

On the mechanism of action of antiarrhythmic agents

Cardiac arrhythmias arise from disturbances in the functioning of the specific ion channels that normally control excitation or from the functional expression of previously latent channels. Antiarrhythmic agents act by blocking the membrane sodium, potassium, and calcium channels, but no agent has exclusive action on a given type of channel. Arrhythmias resulting from reentry form the largest group of clinically significant arrhythmias. Most arrhythmias result from depressed sodium channel function. The local anesthetic class of sodium channel blockers (class I agents) acts by slowing conduction and converting regions of unidirectional block to bidirectional block. Class III agents act by prolonging the action potential duration. Because potassium currents are normally responsible for repolarization of the cardiac action potentials, these agents are generally assumed to be potassium channel blockers. Class IV antiarrhythmics--calcium channel blockers--are used when a group of reentrant arrhythmias arises in regions in which conduction is primarily sustained by increases in permeability to calcium ions. The mechanisms of action of antiarrhythmic agents are discussed with respect to the basic cellular mechanisms of cardiac arrhythmias.

Electrophysiologic substrate of torsade de pointes: dispersion of repolarization or early afterdepolarizations?

Recent experimental and clinical studies suggest that torsade de pointes may be precipitated by early afterdepolarizations in the Purkinje or ventricular muscle fibers. This hypothesis offers an alternative to the earlier one that attributes torsade to the underlying dispersion of repolarization. This review lists the clinical conditions associated with torsade de pointes and examines the experimental background of the two proposed electrophysiologic substrates of torsade, namely, the dispersion of repolarization and the early afterdepolarizations. The strengths and weaknesses of the two hypotheses are compared in relation to the following characteristics of torsade de pointes: facilitation by slow heart rate, suppression by pacing, R on T phenomenon, difficulty of induction by programmed stimulation, aggravation by hypokalemia, manifestation of an idiosyncratic reaction to class IA antiarrhythmic drugs, spontaneous termination, suppression by magnesium salts and isoproterenol and induction by such drugs as sotalol, bepridil and prenylamine. It appears that most clinical observations can be explained by either mechanism, but in some cases difficulties are encountered for the afterdepolarization hypothesis.

Contribution of depolarized foci with variable conduction impairment to arrhythmogenesis in 1 day old infarcted canine cardiac tissue: an in vitro study

To assess the roles of entrance and exit block after canine myocardial infarction, single stage coronary artery ligations of canine circumflex coronary arteries were performed. After 1 day, atria and ventricles were paced using single stimuli and trains. After isolation, simultaneous microelectrode impalements were made in infarcted and uninfarcted tissue. Spontaneous foci, when identifiable, were always located in infarcted tissue. They could frequently be triggered by one or more driven beats, and their activity could often be terminated ("annihilated") by a properly timed beat. Foci with varying combinations of entrance and exit conduction impairment were observed. Variations in conduction characteristics altered the manifest arrhythmic pattern. With partial entrance block and intact exit conduction, foci could be electrotonically modulated and entrained into regular patterns. Activity that emerged from a focus with sufficient conduction delay could modulate the focus, and entrain it to discharge at a slower rate ("autoentrainment"). The results suggest that modulated parasystole may contribute to arrhythmogenesis after canine myocardial infarction and that variations in entrance and exit characteristics of depolarized foci may result in variable and complex arrhythmic patterns.

Ectopic ventricular tachycardia sensitive to calcium antagonists in acute myocardial infarction in dogs

The effects of antiarrhythmic agents on automatic ventricular tachycardia (VT), which emerged in the early stage of acute myocardial infarction (AMI), were examined in 30 closed-chest mongrel dogs. Antiarrhythmic agents were administered intravenously when the rate of VT became almost equal to sinus rate (5.6 +/- 1.4 hours). VT was slowed significantly by verapamil (0.15 or 0.3 mg/kg), diltiazem (0.2 or 0.4 mg/kg), propranolol (0.1 mg/kg) and amiodarone (5 mg/kg), but not by procainamide (20 mg/kg), lidocaine (2 or 4 mg/kg), nifedipine (0.01 mg/kg) and nicorandil (0.03 mg/kg). The number of ventricular premature complexes was reduced most effectively by verapamil. The significant suppressive effects of calcium antagonist drugs (verapamil and diltiazem) and propranolol indicate that an inward calcium current during diastole may play a critical role in the abnormal enhancement of ventricular automaticity in the early stage (4 to 8 hours) of AMI.

Action of dimethindene on the electrophysiological and mechanical properties of atrial and ventricular myocardium of guinea-pig

The effect of dimethindene (DMI) on transmembrane potentials and contractile force was studied in atrial and ventricular myocardium of guinea-pigs. DMI reduced the maximum rate of depolarization (Vmax) without changing the resting potential in both preparations. In ventricular myocardium, DMI shortened the action potential duration and exerted a negative inotropic effect. In atrial muscle, the drug prolonged the action potential duration and induced a positive inotropic effect which could be antagonized with neither the alpha-blocker phentolamine, nor the beta-blocker pindolol, H1-blocker mepyramine and H2-blocker cimetidine. DMI had no effect on the slow action potentials induced by caffeine in K+-depolarized myocardial preparations. The drug consistently shifted the sodium inactivation curve to more negative membrane potentials. The results suggest that DMI has a quinidine-like membrane-stabilizing property, which may be due to its fast Na+ channel blocking activity. The differential inotropic action of the drug in atrial and ventricular myocardium is discussed.

Contribution of variable entrance and exit block in protected foci to arrhythmogenesis in isolated ventricular tissues

Automatic foci with membrane potentials in the range characterized by depolarization-induced automaticity exhibit entrance block. The present study demonstrates a role of variable entrance and exit block in arrhythmogenesis. We studied canine interventricular septa with the right bundle branch exposed, isolated false tendons and isolated feline papillary muscle using standard microelectrode techniques. Foci of automaticity were produced either by focal application of electric current or by exposure of the preparations to Tyrode's solution containing 1.5-2.0 mM KCl. Foci induced by mild depolarization exhibited entrance block with exit conduction and were subject to electrotonic modulation. With greater depolarization, varying degrees of exit block developed. Various rhythms, including Wenckebach periodicity, resulted. Delayed emergence of electrotonically accelerated activity led to closely coupled extrasystoles resembling reentrant activity. Exit conduction in some preparations was facilitated by enhanced normal pacemaker activity (membrane potentials -- 70 mV or greater) in tissue peripheral to the focus. Also, when there were two sites of automaticity separated by an area of depressed conduction, intermodulation between the two automatic regions generated complex arrhythmias. Shifts in maximum diastolic potential also changed conduction and led to changes in arrhythmic patterns. In some experiments, focal automaticity was terminated by single stimuli. We conclude that complex and variable behavior of automatic foci may result in activity with characteristics previously attributed to other arrhythmic mechanisms.

Amantadine-induced diastolic depolarization and automaticity in ventricular muscle

We studied the cardiac effects of amantadine, an antiviral and anti-Parkinson drug. Amantadine hydrochloride (100--800 microM) produced significant changes in the electrophysiological properties of isolated ventricular muscle preparations from frog, rabbit, cat, dog, and calf. At relatively low concentrations (100--300 microM), the drug increased action potential duration, decreased action potential amplitude and maximum diastolic potential, and induced phase 4 depolarization. Amantadine also caused subthreshold diastolic depolarizations, apparent upon cessation of stimulation in all preparations studied. The amplitude of the diastolic depolarizations increased as a function of time and/or concentration of drug, eventually reached threshold, and spontaneous activity ensued. In the steady state, amantadine-induced spontaneous activity was rather stable, and the rate was dependent upon the amantadine and external potassium concentrations, as well as the membrane potential. In the absence of stimulation, amantadine-induced spontaneous activity occurred abruptly or could be triggered by a single stimulus, often occurring in a "bursting" fashion that appeared to originate from multiple discrete foci. All actions of amantadine were rapidly reversed upon washout. Propranolol had no effect on the actions of the drug. Amantadine-induced spontaneous activity was unaffected by lidocaine, diminished by TTX, and reduced or abolished by verapamil. The results indicate that amantadine can directly alter the membrane properties of ventricular muscle, possibly due to an effect on potassium conductance. Furthermore, amantadine can be used as a tool to study the ionic basis of ventricular automaticity and to model cellular mechanisms of ventricular rhythm disturbances.

Inhibition of myocardial K+ channels by bromobenzoyl-methyladamantylamine, an adamantane derivative

The effect of bromobenzoyl-methyladamantylamine (BMA) on transmembrane potentials and contractility of atrial and ventricular myocardium of guinea-pig and cat, as well as on transmembrane ionic currents of the frog atrial trabeculae was studied using conventional glass microelectrode and double sucrose-gap voltage clamp techniques. BMA markedly prolonged the action potential duration, depolarized the cell membrane, reduced the rate of rise of the action potential and exerted a positive inotropic effect on non-clamped myocardial preparations. The drug-induced pacemaker activity in ventricular working muscle of cat. Moreover, BMA antagonized the effects of the K+ channel activator acetylcholine in a dose-dependent manner. BMA was found to induce slow response action potentials in K+ -depolarized ventricular myocardium of guinea-pig. In voltage clamp experiments, BMA reduced the outward K+ current but had no effect on either rapid inward Na+ or slow inward Ca2+ currents. The results suggest that BMA is capable of selectively blocking the myocardial K+ channels.

Biphasic effects of acetylstrophanthidin on automaticity in guinea pig ventricular muscle

The effects of acetylstrophanthidin (AS) on depolarization-induced automaticity and contractility of guinea pig papillary muscle were studied in a single sucrose gap chamber with microelectrode and current-clamp techniques. The concentration used, 1.4-1.8 microM, never induced automaticity in preparations at their normal resting potential. Twenty min after superfusion with AS, action potential duration (APD) was prolonged and the force of contraction increased. These were associated with an increase in slope of phase 4 depolarization and an increase in the membrane resistance (Rm) of muscles depolarized with small constant current pulses. With longer (50-80 min) periods of AS superfusion, APD became shorter, Rm decreased to less than predrug values, and in depolarized preparations, the slope of phase 4 decreased. Contractility remained unchanged throughout this second phase. All of these effects were fully reversible upon 60 min of superfusion with AS-free Tyrode solution. We suggest that the biphasic effects of AS on the automaticity of depolarized ventricular muscle cells are caused by an initial decrease followed by a later increase in transmembrane potassium conductance.

Two types of abnormal automaticity in canine ventricular muscle fibers

When ventricular muscle fibers from dog hearts were exposed to different [Ca2+]0 in K+-free solutions, two types of abnormal automaticity were observed. In the K+-free, Ca2+-free, solution, 9 out of 55 preparations developed spontaneous activity at a reduced membrane potential. The maximum diastolic potential was -47.4 +/- 7.68 mV (n = 9) with slow (less than 20 V/s) upstroke velocity of action potentials. The automaticity was based on membrane oscillations with increasing amplitude to become full-sized responses. It was suppressed after reduction of [Na+]0, by an increase in [Ca2+]0 above 3.6 mmol/l and by application of verapamil. In the K+-free, high-Ca2+, solutions (Ca2+ = 3.6-7.2 mmol/l), oscillatory afterpotentials (OAPs) were observed following the driven action potentials at normal membrane potentials in all 55 preparations. Once the OAPs became large enough to attain threshold, there was the appearance of triggered-automaticity. The automaticity was induced by applying premature stimuli or manipulating [Ca2+]0. It was abolished by application of either verapamil or tetrodotoxin by decreasing the amplitude of the OAPs or the fast Na+ current, respectively, or both in combination. These results indicate that the ventricular muscle fibers can develop abnormal automaticity of two different mechanisms in some conditions, and can be a focus of ectopic impulse formation.

Role of neurotransmitter release and cyclic AMP-dependent membrane phosphorylation in low voltage myocardial automaticity

Low voltage myocardial automaticity (LVA) was investigated by pharmacological modulations of the presynaptic and postsynaptic processes. The sensitivity of LVA both to inhibitor and stimulator of neurotransmitter release suggests its involvement in LVA genesis. Moreover, LVA is blocked by the inhibition of the cyclic AMP system, supporting the participation of the c-AMP-dependent membrane phosphorylation in calcium-mediated cardiac electrogenesis.

Physiological role of endogenous amines in the modulation of ventricular automaticity in the guinea-pig

1. Current-clamp experiments were carried out with guinea-pig papillary muscles to determine the dependence of depolarization-induced automaticity on endogenous catecholamines. 2. Catecholamine depletion was produced by pre-treatment of animals with 6-hydroxydopamine and confirmed by fluorimetric assay of right ventricular tissue. Papillary muscles from depleted animals demonstrated a marked suppression of depolarization-induced automaticity for maximum diastolic potentials less negative than -55 mV. This suppression was completely reversed by noradrenaline but not by tyramine. 3. In normal tissue, noradrenaline and tyramine had much smaller effects on automaticity arising from maximum diastolic potentials negative to -55 mV than on repetitive activity arising positive to this level. 4. L-propranolol in concentrations of 2-3 x 10(-7) M reduced repetitive activity in the less negative range of maximum diastolic potential. No evidence of direct membrane depression was observed at these doses and the effect was reversed by application of noradrenaline. 5. D-propranolol, the isomer with much lower beta-receptor blocking potency, required twentyfold higher concentrations to depress automaticity and this was accompanied by evidence of direct membrane depression, i.e. reduction of upstroke velocity of action potentials. 6. These results show that automaticity induced in guinea-pig papillary muscles by depolarization positive to -55 mV is strongly dependent upon endogenous catecholamines. 7. The hypothesis that endogenous catecholamines facilitate depolarization-induced automaticity through an increase in calcium conductance was modelled using numerical techniques. It was found that changes in calcium conductance caused changes in the model which closely parallelled the experimental effects of catecholamine depletion and beta-blockade. The effects of changes in delayed rectification in the model did not accurately reproduce the experimental results.

Automaticity and entrance block induced by focal depolarization of mammalian ventricular tissues

Isolated canine interventricular septa were studied with standard microelectrode techniques. Focal automaticity was induced by applying depolarizing current through an extracellular pipet in contact with the right bundle branch (RBB) of the ventricular specialized conducting system. Automaticity appeared with depolarization to transmembrane potentials of -50 mV or less. The spontaneous activity was neither depressed nor accelerated when overdrive suppression was attempted. Activity originating within the focus propagated into fully polarized surrounding tissue. However, entrance block, phasically related to the spontaneous cycle length, was an intrinsic property of these foci. Early premature beats initiated outside the focus failed to enter the focus, but the resulting electrotonus delayed the next automatic beat. Late premature beats captured and thereby accelerated the focus. Thus, the automatic foci could be extrafocal activity. Consequently, continous pacing at various rates precipitated complex rhythms with fixed coupling. Similar foci with exit conduction, entrance block, and electrotonic modulation also were demonstrated in focally depolarized papillary muscles in feline septal preparations. The unique properties of focally depolarized areas in which spontaneous activity is generated at low membrane potentials provide a mechanism capable of generating a wide array of arrhythmias.

Effects of K+ and K+-induced polarization on (dV/dt)max, threshold potential, and membrane input resistance in guinea pig and cat ventricular myocardium

We studied the non-membrane potential-dependent effect of K+ on (dV/dt)max and threshold potential in guinea pig and cat ventricular myocardium. Membrane potential (MP) was changed uniformly in segments (length less than or equal to 1.0 mm) of papillary muscles by applying extracellular polarizing current pulses across a single sucrose gap. Control [K+]o was 5.4 mM and test [K+]o values were 2.0, 10.0, 11.5, 13.0, 16.2, 20, 22, and 24.0 mM. Each muscle was studied under four conditions: (1) control [K+]o and unaltered (control level) resting MP (Em); (2) one of the test [K+]o values and the unaltered (test level) Em; (3) the same test [K+]o and Em held at the control level; (4) control [K+]o and Em held at the test level. At all [K+]o greater than or equal to 11.5 mM, (dV/dt)max showed a decrease significantly (P less than 0.01) greater than the corresponding MP-dependent decrease in both guinea pig and cat myocardium. This non-MP-dependent decrease averaged 7.5% at 11.5 mM, 26.5% at 13.0 mM, 37.2% at 16.2 mM, and 22.7% at 20.0 mM. At [K+]o greater than or equal to 20.0 mM, (dV/dt)max was predominantly slow-channel-dependent; it was increased by hyperpolarization to -110 mV at [K+]o = 20 and 22 mM but not at [K+]o = 24mM. Threshold potential became progressively less negative with increasing [K+]o, but this effect was dependent only on MP. The membrane input resistance (rm) was determined by two opposing factors: at a given [K+]o, rm increased with depolarization; and at a given MP, rm decreased with increasing [K+]o. Our study shows that non-MP-dependent depression of (dV/dt)max in the ventricular myocardium occurs at [K+]o concentrations that may be encountered in vivo.

Effects of palytoxin on mechanical and electrical activities of guinea pig papillary muscle

Effects of palytoxin (PTX) on isolated papillary muscles of guinea pigs were studied in an attempt to elucidate the mechanical and electrical activities. Inotropic effects of PTX above 3 x 10(-9) g/ml; an early positive inotropic effect, slowly developing contracture accompanied by decline in phasic tension, appearance of aftercontractions and arrhythmias at high doses. The positive inotropic effect of PTX was enhanced in high Ca2+ medium but was not modified by propranolol. PTX induced a sustained depolarization and decrease in the amplitude, upstroke velocity and duration of action potential. During development of depolarization, arrhythmias occurred, which lasted for 5--10 min and reappeared 30--60 min after. Oscillatory afterpotential often appeared. Neither reserpine nor practolol prevented the PTX-induced arrhythmia while propranolol prevented it. Tetrodotoxin slowed the development of depolarization due to PTX and inhibited PTX-arrhythmias. In low Na+ medium, PTX exerted fewer effects on resting and action potentials and produced no arrhythmia. The results suggest that PTX-induced depolarization is responsible for the generation of contracture and arrhythmia and that the depolarization is due to the change in membrane Na permeability.

Oscillatory after-potentials and triggered-automaticity in mammalian ventricular muscle fibres at high resting potentials

Oscillatory after-potentials and triggered-automaticity were observed in dog ventricular muscle fibres when the fibres were exposed to K+-free,high-Ca++-solutions after K+-free,Ca++-free perfusion. They appeared at membrane potentials more negative than--60 m V.

Antiarrhythmic and electrophysiological effects of CH-200

A new antiarrhythmic drug CH-200, 5-phenacyl-thieno[3,2-c]yridinium, was compared with procainamide and lidocaine in a two-stage coronary ligation arrhythmia model for its efficacy and electrophysiological properties. CH-200 suppressed arrhythmia in beagle dogs more effectively than did procainamide and lidocaine. The antiarrhythmic effects of CH-200 and procainamide developed slowly and lasted longer than those of lidocaine. Electrophysiological studies with CH-200 showed that it decreased max dV/dt of the action potential. This effect was dependent on the heart rate: the higher the rate, the stronger the effect. CH-200, procainamide and lidocaine prolonged the effective refractory period and this effect seemed to be responsible for suppressing the arrhythmia after coronary ligation. CH-200 and procainamide increased the frequency of ventricular pacemaker activity, while lidocaine decreased it. These effects appear to be unimportant for the antiarrhythmic effects.

The effects of diphenylhydantoin on mechanical and electrical properties of isolated cat myocardium

The effects of diphenylhydantoin (DPH) (4 X 10(-5) to 2 X 10(-4) M) on contractile activity and electrical properties were studied in isotonically shortening cat papillary muscles exposed to DPH. 1. DPH reduces amplitudes of contraction especially at low stimulation rates (6 to 12/min). At higher, more physiological rates the negative inotropic effect is comparatively small. 2. DPH accentuates the mechanical transients usually following step changes of frequency. 3. DPH reduces the maximum rate of depolarisation (MRD) of the normal action potential (AP) and slows conduction especially at high stimulation rates. AP duration is shortened especially at low stimulation rates. 4. In Ca-mediated "slow responses" DPH reduces MRD, overshoot and AP duration and abolishes the frequency-dependent alterations of these parameters. 5. The results suggest that the antiarrhythmic potency of DPH is due to a cooperative action on both the fast and the slow membrane channels. 6. It is speculated that DPH leads to an accumulation of Ca2+ within a "limited subsarcolemmal space" thereby decreasing the driving force for the slow inward current.

Effects of extracellular potassium on ventricular automaticity and evidence for a pacemaker current in mammalian ventricular myocardium

Automaticity was induced in isolated guinea pig and cat papillary muscles by application of depolarizing constant current pulses. Increasing extracellular potassium from 1 to 15 mM caused a shift of pacemaker-like activity to less negative diastolic potentials and a decrease in maximum phase 4 slope. Membrane resistance, estimated from the relation of applied current to maximum diastolic potential, decreased when extracellular potassium was increased. Voltage clamps of cat papillary muscle demonstrated that action potentials activate a time-dependent outward current which has a reversal potential of -79.1 mV (+/- 0.99 SE, n = 20) at an extracellular potassium concentration of 5 mM. The reversal potential of this current varies with extracellular K+ with a slope of 50-60 mV per 10-fold concentration change. The current is activated by voltage clamps or action potential plateaus in the range of -30 to +30 mV. It has a time constant of deactivation which increases from approximately 100 to over 400 msec as clamp potential is increased from -90 to -60 mV. It is proposed that this current is equivalent to Ix1 demonstrated in other cardiac tissues and is responsible, in combination with inward currents, for automaticity in ventricular fibers.

Automatic activity in depolarized guinea pig ventricular myocardium. Characteristics and mechanisms

Membrane potential was changed uniformly in segments, 0.7-1.0 mm long, of guinea pig papillary muscles excised from the right ventricle by using extracellular polarizing current pulses applied across two electrically insulated cf preparations superfused with Tyrode's solution at maximum diastolic membrane potentials ranging from-35.2+/-7.5 (threshold) to +4.0+/-9.2 mV. The average maximum dV/dt of RAD ranged from 17.1 to 18.0 V/sec within a membrane potential range of -40 to +20 mV. Raising extracellular Ca2+ concentration [Ca2+]0 from 1.8 to 6.8 mM, or application of isoproterenol (10(-6)g/ml) enhanced the rate of RAD, but lowering [Ca2+]0 to 0.4 mM or exposure to MnCl2 (6 mM) abolished RAD. RAD were enhanced by lowering extracellular K+ concentration [K+]0 from 5.4 to 1.5 mM. RAD were suppressed in 40% of fibers by raising [K+]0 to 15.4 mM, and in all fibers by raising [K+]0 to 40.4 mM. This suppression was due to increased [K+]0 and not to K-induced depolarization because it persisted when membrane potential was held by means of a conditioning hyperpolarizing puled gradually after maximum repolarization. These observations suggest that the development of RAD in depolarized myocardium is associated with a time-dependent decrease in outward current (probably K current) and with increase in the background inward current, presumably flowing through the slow cha-nel carrying Ca or Na ions, or both.

Effects of extracellular calcium and sodium on depolarization-induced automaticity in guinea pig papillary muscle

Regenerative discharge of action potentials is induced in mammalian papillary muscles by passage of small depolarizing currents. In this paper, the effects of various extracellular calcium and sodium concentrations and of tetrodotoxin on this phenomenon were studied in guinea pig papillary muscles in a sucrose gap chamber. Phase 4 diastolic depolarization was found to be associated with an increase in membrane resistance. The slope of phase 4 depolarization was decreased by reductions in extracellular calcium or sodium concentration. The range of maximum diastolic potentials and the thresholds from which regenerative potentials arose were reduced, especially at the positive limit of potentials, by a reduction in either ion. It was concluded that both calcium and sodium influence diastolic depolarization and participate in the regenerative action potentials of depolarization-induced ventricular automaticity.

Dual effects of calcium ions on pacemaker activity in guinea-pig taenia coli

The effects of various [Ca2+]0 on membrane potential (MP), action potential (AP) frequency, and isometric tension of isolated guinea-pig taenia coli were studied using intracellular recording techniques and simultaneous tension measurement. At 5.9 mM [K+]0 the order of potency of [Ca2+]0 this order is gradually reversed since high [Ca2+]0 becomes more potent in accelerating impulse discharges. At 2.5 mM [Ca2+]0 the line relating MP to log [K+]0 is not straight; its slope for a tenfold change of [K+]0 is 21.1 mV in the range between 5.9 and 17.7 mM [K+]0, and 51.5 mV between 32.45 and 59 mM [K+]0. In general, reducing [Ca2+]0 depolarizes the membrane whereas increasing [Ca2+]0 hyperpolarizes it. The Ca2+-induced changes of MP are reduced at high [K+]0. At 2.5 and 7.5 mM [Ca2+]0 the lines relating AP frequency and tension to the MP are nearly superimposed. In contrast, at 0.83 mM [Ca2+]0 the line is shifted to lower frequency and tension for all MP values studied. In conclusion, in the range of low [Ca2+]0 the system underlying pacemaker activity seems to be dependent on Ca2+ in two ways: 1. by an indirect negative action mediated by an increase of PK+ and by hyperpolarization of the membrane; 2. by a direct positive action which is not mediated by alterations of MP. In the range of normal and high [Ca2+]0 only potential-mediated Ca2+-effects determine AP frequency. The hypothesis is put forward that Ca2+ may carry the background inward current responsible for pacemaker activity.

Optical isomers of verapamil on canine heart. Prevention of ventricular fibrillation induced by coronary artery occlusion, impaired atrioventricular conductance and negative inotropic and chronotropic effects

Effects of optical isomers of verapamil on the canine heart were measured with a pressure catheter in the left ventricle and with the electrocardiogram. 1. Both isomers of verapamil caused impaired atrioventricular conduction. slowed the rate of the sinus pacemaker and depressed the contractile state of the myocardium. (-)-Verapamil was consistently more potent than (+)-verapamil in producing these effects. (-)/(+) potency ratios of 10 and 3 were estimated for atrioventricular blockade and for the negative chronotropic effect, respectively. 2. Negative inotropic effects of 0.06-2.0 mg/kg of (+)-verapamil were determined on hearts paced at constant rate. A similar dose-response relationship could not be established with (-)-verapamil because at concentration higher than 0.06 mg/kg the hearts did not follow the supraventricular driving stimulus. With doses of (-)- and (+)-verapamil which produced the same slowing of the sinus pacemaker rate in spontaneously beating hearts, (-)-verapamil caused greater negative inotropic effects than (+)-verapamil. 3. The following doses of isomers of verapamil reduced the incidence of ventricular fibrillation induced by coronary artery ligation: 0.2 mg/kg (-)-verapamil (P less than 0.001), 0.6 mg/kg (-)-verapamil (P less than 0.001) and 0.6 mg (+)-verapamil (P less than 0.01). 4. Intravenous administration of CaCl2 to dogs treated with either isomer of verapamil restored the contractile state and reversed atrioventricular blockade to sinus rhythm. Dog ventricles under the influence of concentrations of isomers of verapamil which, with normal plasmatic Ca2+-content, prevent fibrillation, consistently fibrillated after coronary artery occlusion when high doses of CaCl2 were administered. 5. The effects of the optical isomers of verapamil may occur predominantly via a blockade of the slow inward Ca2+-current.

Inotropic and electrophysiological actions of verapamil and D 600 in mammalian myocardium. III. Effects of the optical isomers on transmembrane action potentials

Excitability, maximum velocity of depolarization (MVD), conduction velocity, discharge rate and the duration of transmembrane action potentials as a function of frequency of stimulation were studied in isolated cardiac tissues exposed to the optical isomers of verapamil and D 600.