Cardiac muscle: excitability and passive electrical properties

Ionic currents underlying different patterns of electrical activity in working cardiac myocytes of mammals and non-mammalian vertebrates

The orderly contraction of the vertebrate heart is determined by generation and propagation of cardiac action potentials (APs). APs are generated by the integrated activity of time- and voltage-dependent ionic channels which carry inward Na⁺ and Ca²⁺ currents, and outward K⁺ currents. This review compares atrial and ventricular APs and underlying ion currents between different taxa of vertebrates. We have collected literature data and attempted to find common electrophysiological features for two or more vertebrate groups, show differences between taxa and cardiac chambers, and indicate gaps in the existing data. Although electrical excitability of the heart in all vertebrates is based on the same superfamily of channels, there is a vast variability of AP waveforms between atrial and ventricular myocytes, between different species of the same vertebrate class and between endothermic and ectothermic animals. The wide variability of AP shapes is related to species-specific differences in animal size, heart rate, stage of ontogenetic development, excitation-contraction coupling, temperature and oxygen availability. Some of the differences between taxa are related to evolutionary development of genomes, which appear e.g. in the expression of different Na⁺ and K⁺ channel orthologues in cardiomyocytes of vertebrates. There is a wonderful variability of AP shapes and underlying ion currents with which electrical excitability of vertebrate heart can be generated depending on the intrinsic and extrinsic conditions of animal body. This multitude of ionic mechanisms provides excellent material for studying how the function of the vertebrate heart can adapt or acclimate to prevailing physiological and environmental conditions.

Cardiac Toxicity of Cadmium Involves Complex Interactions Among Multiple Ion Currents in Rainbow Trout (Oncorhynchus mykiss) Ventricular Myocytes

Cadmium (Cd²⁺ ) is cardiotoxic to fish, but its effect on the electrical excitability of cardiac myocytes is largely unknown. To this end, we used the whole-cell patch-clamp method to investigate the effects of Cd²⁺ on ventricular action potentials (APs) and major ion currents in rainbow trout (Oncorhynchus mykiss) ventricular myocytes. Trout were acclimated to +4 °C, and APs were measured at the acclimated temperature and elevated temperature (+18 °C). Cd²⁺ (10, 20, and 100 µM) altered the shape of the ventricular AP in a complex manner. The early plateau fell to less positive membrane voltages, and the total duration of AP prolonged. These effects were obvious at both +4 °C and +18 °C. The depression of the early plateau is due to the strong Cd²⁺ -induced inhibition of the L-type calcium (Ca²⁺ ) current (I_CaL ), whereas the prolongation of the AP is an indirect consequence of the I_CaL inhibition: at low voltages of the early plateau, the delayed rectifier potassium (K⁺ ) current (I_Kr ) remains small, delaying repolarization of AP. Cd²⁺ reduced the density and slowed the kinetics of the Na⁺ current (I_Na ) but left the inward rectifier K⁺ current (I_K1 ) intact. These altered cellular and molecular functions can explain several Cd²⁺ -induced changes in impulse conduction of the fish heart, for example, slowed propagation of the AP in atrial and ventricular myocardia (inhibition of I_Na ), delayed relaxation of the ventricle (prolongation of ventricular AP duration), bradycardia, and atrioventricular block (inhibition of I_CaL ). These findings indicate that the cardiotoxicity of Cd²⁺ in fish involves multiple ion currents that are directly and indirectly altered by Cd²⁺ . Through these mechanisms, Cd²⁺ may trigger cardiac arrhythmias and impair myocardial contraction. Elevated temperature (+18 °C) slightly increases Cd²⁺ toxicity in trout ventricular myocytes. Environ Toxicol Chem 2021;40:2874-2885. © 2021 SETAC.

Feeling the heat: source–sink mismatch as a mechanism underlying the failure of thermal tolerance

A mechanistic explanation for the tolerance limits of animals at high temperatures is still missing, but one potential target for thermal failure is the electrical signaling off cells and tissues. With this in mind, here I review the effects of high temperature on the electrical excitability of heart, muscle and nerves, and refine a hypothesis regarding high temperature-induced failure of electrical excitation and signal transfer [the temperature-dependent deterioration of electrical excitability (TDEE) hypothesis]. A central tenet of the hypothesis is temperature-dependent mismatch between the depolarizing ion current (i.e. source) of the signaling cell and the repolarizing ion current (i.e. sink) of the receiving cell, which prevents the generation of action potentials (APs) in the latter. A source–sink mismatch can develop in heart, muscles and nerves at high temperatures owing to opposite effects of temperature on source and sink currents. AP propagation is more likely to fail at the sites of structural discontinuities, including electrically coupled cells, synapses and branching points of nerves and muscle, which impose an increased demand of inward current. At these sites, temperature-induced source–sink mismatch can reduce AP frequency, resulting in low-pass filtering or a complete block of signal transmission. In principle, this hypothesis can explain a number of heat-induced effects, including reduced heart rate, reduced synaptic transmission between neurons and reduced impulse transfer from neurons to muscles. The hypothesis is equally valid for ectothermic and endothermic animals, and for both aquatic and terrestrial species. Importantly, the hypothesis is strictly mechanistic and lends itself to experimental falsification.

The temperature dependence of electrical excitability in fish hearts

Environmental temperature has pervasive effects on the rate of life processes in ectothermic animals. Animal performance is affected by temperature, but there are finite thermal limits for vital body functions, including contraction of the heart. This Review discusses the electrical excitation that initiates and controls the rate and rhythm of fish cardiac contraction and is therefore a central factor in the temperature-dependent modulation of fish cardiac function. The control of cardiac electrical excitability should be sensitive enough to respond to temperature changes but simultaneously robust enough to protect against cardiac arrhythmia; therefore, the thermal resilience and plasticity of electrical excitation are physiological qualities that may affect the ability of fishes to adjust to climate change. Acute changes in temperature alter the frequency of the heartbeat and the duration of atrial and ventricular action potentials (APs). Prolonged exposure to new thermal conditions induces compensatory changes in ion channel expression and function, which usually partially alleviate the direct effects of temperature on cardiac APs and heart rate. The most heat-sensitive molecular components contributing to the electrical excitation of the fish heart seem to be Na+ channels, which may set the upper thermal limit for the cardiac excitability by compromising the initiation of the cardiac AP at high temperatures. In cardiac and other excitable cells, the different temperature dependencies of the outward K+ current and inward Na+ current may compromise electrical excitability at temperature extremes, a hypothesis termed the temperature-dependent depression of electrical excitation.

Effects of seasonal acclimatization on temperature dependence of cardiac excitability in the roach, Rutilus rutilus

Temperature sensitivity of electrical excitability is a potential limiting factor for performance level and thermal tolerance of excitable tissues in ectothermic animals. To test whether the rate and rhythm of the heart acclimatize to seasonal temperature changes, thermal sensitivity of cardiac excitation in a eurythermal teleost, the roach (Rutilus rutilus), was examined. Excitability of the heart was determined from in vivo electrocardiograms and in vitro microelectrode recordings of action potentials (APs) from winter and summer roach acclimatized to 4 and 18°C, respectively. Under heat ramps (3°C h(-1)), starting from the acclimatization temperatures of the fish, heart rate increased to maximum values of 78±5 beats min(-1) (at 19.8±0.5°C) and 150±7 beats min(-1) (at 28.1±0.5°C) for winter and summer roach, respectively, and then declined in both groups. Below 20°C, heart rate was significantly higher in winter than in summer roach (P<0.05), indicating positive thermal compensation. Cardiac arrhythmias appeared with rising temperature as missing QRS complexes, increase in variability of heart rate, episodes of atrial tachycardia, ventricular bradycardia and complete cessation of the heartbeat (asystole) in both winter and summer roach. Unlike winter roach, atrial APs of summer roach had a distinct early repolarization phase, which appeared as shorter durations of atrial AP at 10% and 20% repolarization levels in comparison to winter roach (P<0.05). In contrast, seasonal acclimatization had only subtle effects on ventricular AP characteristics. Plasticity of cardiac excitation appears to be necessary for seasonal improvements in performance level and thermal resilience of the roach heart.

The heart cell--electrophysiological aspects

A short review is given of the ionic fluxes associated with the action potential in Purkinje fibres, and in sinus and AV-node, and of the influence of variations in the extracellular concentrations of K+, Na+, Ca2+ and Mg2+ on basic electrophysiological parameters. Variations in serum potassium concentration often plays an important role in the genesis of arrhythmias by changing several electrophysiological parameters, whereas only extreme variations in the serum calcium level produce electrophysiological effects of clinical importance. Hypo- and hypernatremia within the ranges observed clinically most probably do not produce significant electrophysiological changes. Variations in extracellular magnesium concentration seem to have effects on electrophysiological parameters particularly when they occur simultaneously with changes in the concentrations of calcium and potassium.

Fractionated electrograms from a computer model of heterogeneously uncoupled anisotropic ventricular myocardium

BACKGROUND

The relation between heterogeneously coupled myocardium and fractionated electrograms is incompletely understood. The purpose of this study was to use a detailed computer model of nonuniformly anisotropic myocardium to test the hypothesis that spatial variation of morphology of electrograms recorded simultaneously from multiple sites increases with increasing heterogeneity of intercellular coupling.

METHODS AND RESULTS

A sheet of elements with Beeler-Reuter ionic kinetics was coupled with cytoplasmic resistivity to model cells. Gap junctional resistance values were assigned by recursive randomization to produce a fractal pattern of heterogeneous coupling, simulating damage resulting from infarction. The correlation dimension of the pattern, D, measured heterogeneity of intercellular coupling. The peak-to-peak amplitude, duration, minimum derivative (steepest downslope), number of inflections, frequency of peak power, and bandwidth of unfiltered unipolar electrograms were calculated. Linear regressions indicate (P < .001) that the coefficient of variation of five electrogram metrics increases with increasing substrate heterogeneity and that the distance over which electrogram morphology decorrelates decreases with increasing heterogeneity of intercellular coupling.

CONCLUSIONS

These findings confirm our hypothesis that the spatial variation of morphology of electrograms recorded simultaneously from multiple sites increases with increasing heterogeneity of intercellular coupling.

The effect of quinidine and myocardial ischemia on the isolated rat heart with fat-free diet

Fat-free diet changes the lipid content and the electrophysiological properties of the rat myocardium. Five percent fat supplementation to the diet does not alter the basic electrophysiological properties but still has a biochemical effect on the lipid content of the myocardium. The purpose of this work was to determine whether these biochemical alterations affect the response of the myocardium to quinidine and ischemia, both of which interact with the lipid component of the membrane. We used strength-duration, strength-interval and threshold of ventricular fibrillation to measure the electrophysiological properties of the isolated rat heart at baseline and after 30 minutes of quinidine perfusion or coronary artery ligation. The fatty acid composition of the myocardium was analyzed. We found that a fat-free diet caused essential fatty-acid deficiency, while 5% fat supplementation had a partial protective effect. Quinidine decreased excitability and increased refractoriness in both groups but had more effect on the fat-free diet hearts group. There was no difference in the ventricular fibrillation threshold. Ischemia increased myocardial excitability in the fat-free diet hearts group and had no effect on refractoriness or ventricular fibrillation threshold. These results support the theory that the lipid composition of the myocardial membrane affects its response to lipophilic drugs and ischemia.

Effects of coupling heterogeneity on fractionated electrograms in a model of nonuniformly anisotropic ventricular myocardium

To further understand the relation between heterogeneously infarcted myocardium and fractionated electrograms, a computer model was used to test the hypothesis that the way electrogram metrics change with electrode location relates to statistical properties of the underlying myocardium. A sheet of Beeler-Reuter elements was coupled with cytoplasmic resistance to form cells. Junctional resistance values were assigned using a recursive randomization to produce a fractal pattern, simulating damage from disrupted blood supply. The pattern's correlation dimension, D, was a statistical measure of heterogeneity. Unipolar electrogram's amplitude, duration, number of inflections, peak frequency, bandwidth, and the rate of change of metrics with height were calculated. Analysis of variance indicated (P < .0001) that peak-to-peak amplitude and bandwidth decreased at a slower rate when height was increased above heterogeneous tissue as compared with homogeneous tissue. These findings could be useful during clinical mapping procedures as statistical estimates of tissue structure.

Effects of flecainide on ectopic atrial automaticity and conduction

BACKGROUND

Previous studies have shown that class Ic antiarrhythmic agents are effective in suppressing ectopic atrial rhythms and accessory pathway conduction.

METHODS AND RESULTS

To explore the potential mechanisms for their effectiveness, we investigated the concentration-dependent effects of the Ic agent flecainide acetate (0.5 to 10 micrograms/mL) on atrial ectopic automaticity and exit conduction in isolated rabbit tricuspid valves. This experimental model consists of three major cell types as defined anatomically and by intracellular recordings: pacemaker, transitional, and working atrial muscle. Simultaneous recordings from these cell types before and during flecainide superfusion (n = 7) showed that the drug produced a slight, concentration-dependent slowing of pacemaker-transitional conduction but elicited third-degree transitional-working atrial muscle block in six of seven preparations at 10 micrograms/mL. Flecainide caused a significant dose-dependent reduction in the initial phase of diastolic depolarization of pacemaker cells but produced only a small, biphasic change in spontaneous pacemaker cycle length. It also caused a significant prolongation in action potential duration in pacemaker and transitional cells and reduction in upstroke velocity in atrial cells. Of note in four additional preparations, flecainide caused a concentration-dependent upward shift in the strength-duration curve for atrial fibers.

CONCLUSIONS

These data suggest that flecainide has little direct effect on ectopic atrial automaticity but rather causes exit conduction slowing and block between transitional and atrial muscle fibers. The mechanism for the induction of block is likely due to a decrease in atrial excitability creating a greater electrical load on generated impulses.

Reduced content of connexin43 gap junctions in ventricular myocardium from hypertrophied and ischemic human hearts

BACKGROUND

Gap junctions are a determinant of myocardial conduction. Disturbances of gap-junctional content may account for abnormalities of impulse propagation, contributing to the arrhythmic tendency and mechanical inefficiency of ischemic and hypertrophied myocardium. The aim of this study was to characterize gap junction organization in normal human ventricular myocardium and to establish whether abnormalities exist in myocardium of chronically ischemic and hypertrophied hearts.

METHODS AND RESULTS

Cardiac gap-junctional connexin43 antibodies and confocal microscopy were used in a quantitative immunohistochemical study of surgical myocardial samples to explore the structural basis of electromechanical ventricular dysfunction in chronic ischemic and hypertrophic heart diseases. Normal adult human left ventricular myocardium had a gap-junctional surface area of 0.0051 micron2/micron3 myocyte volume; gap junctions were confined to intercalated disks, of which there was a mean of 11.6 per cell. The right ventricle showed similar gap junction surface area. Left ventricular myocardium from ischemic hearts (distant from any fibrotic scarring), despite normal numbers of intercalated disks per cell, had a reduced gap junction surface area (0.0027 micron2/micron3; P = .02), as did hypertrophied myocardium (0.0031 micron2/micron3; P = .05). The cardiac myocytes in the pathological tissues were larger than normal, and estimated gap-junctional content per cell was reduced in ischemic ventricle (P = .02) compared with normal.

CONCLUSIONS

Gap junctions in normal adult human working ventricular myocardium occupy an area of 0.0051 micron2/micron3 myocyte volume. This surface area is reduced in ventricular myocardium from hearts subject to chronic hypertrophy and ischemia, despite a normal number of intercellular abutments, and this alteration may contribute to abnormal impulse propagation in these hearts.

Influence of dietary fat on the pharmacodynamics of propafenone in isolated, perfused rabbit hearts

BACKGROUND

The fatty acid composition of the phospholipids in sarcolemma may significantly influence cell membrane functions. We evaluated the effects of dietary fat on the pharmacodynamics of the antiarrhythmic drug propafenone in isolated, perfused rabbit hearts.

METHODS AND RESULTS

Three groups of weanling rabbits (n = 9 each group) were fed diets of 10% wt/wt lard, fish oil, or safflower oil for 40 days. Differences in electrophysiological variables were assessed at baseline and during propafenone perfusion. Myocardial concentration-effect relations were determined by plotting electrophysiological effects versus coronary sinus propafenone concentrations. The linoleic acid content of isolated sarcolemma was higher in the safflower group (33.4 +/- 11.4%) than in the lard (13.4 +/- 2.3%, p less than 0.01) and fish oil (8.5 +/- 1.4%, p less than 0.01) groups, whereas the omega-3 fatty acid content was higher in the fish oil group (p less than 0.01). During propafenone perfusion, greater changes in ventricular conduction time were observed in the lard group (22 +/- 11 msec) than in the safflower oil group (10 +/- 7 msec, p less than 0.05), whereas changes in ventricular conduction time in the fish oil group (16 +/- 7 msec) were intermediate between the lard and safflower oil groups. The slopes of the linear myocardial concentration-effect relations describing changes in QRS duration were steeper in the lard group (0.22 +/- 0.07 msec/micrograms/ml) than in the safflower oil group (0.13 +/- 0.04 msec/micrograms/ml, p less than 0.01) but not in the fish oil group (0.17 +/- 0.08 msec/microgram/ml, p = NS). Strength-interval curves were similar at baseline in all three groups. During propafenone perfusion, the threshold current was increased significantly at long coupling intervals (250-380 msec) in the lard group (1.8 +/- 1.0 mA) compared with the safflower oil group (0.8 +/- 0.6 mA, p less than 0.05) but not compared with the fish oil group (1.2 +/- 0.6 mA, p = NS).

CONCLUSIONS

Dietary fat significantly alters the fatty acid composition of the phospholipids in sarcolemma. Propafenone effects on ventricular conduction time and ventricular excitability are significantly influenced by the type of dietary fat.

Cellular uncoupling can unmask dispersion of action potential duration in ventricular myocardium. A computer modeling study

Although slow conduction is a requirement for the preparation of sustained reentry, it alone is not sufficient for the initiation of reentry. Additionally, unidirectional block and recovery of excitability distal to the site of block must occur. Thus, a comprehensive description of the electrophysiological determinants of reentry must explain both slow conduction and unidirectional block. Although there is a growing body of research exploring the influence of axial resistivity and anisotropy on slow conduction, somewhat less is known about the relation of axial resistivity to spatial dispersion of action potential duration, a condition favorable to the development of unidirectional block. We hypothesized that when cells are well coupled, local differences in intrinsic action potential duration are not evident and that, as axial resistivity increases, local variation in action potential duration becomes manifest. We tested this hypothesis in a numerical model of electrical propagation in a grid of resistively coupled ionic current sources simulating a sheet of ventricular myocardium. Spatial dispersion of intrinsic action potential duration was simulated by varying the magnitude of the fully activated slow inward conductance in Beeler-Reuter membrane ionic kinetics. By then altering coupling resistance, we showed that dispersion of manifest action potential duration is masked in the setting of normal low-resistance cellular coupling and unmasked by increased axial resistance. When nonuniform anisotropy was simulated, dramatic pacing-site-dependent changes in both the pattern of activation and dispersion of action potential duration were noted. These findings may be important in understanding the mechanism of reentrant tachycardia initiation in the border zone of chronic, healed myocardial infarctions where evidence suggests that abnormal cellular coupling is the predominant electrophysiological derangement. In this study, we have shown, using a detailed ionic current-based model of cardiac electrical propagation, that changes in axial resistivity can modulate how spatial dispersion of intrinsic action potential duration is manifest.

Electrical restitution and conduction intervals of ventricular premature beats in man: influence of heart rate

Monophasic action potentials (MAP) were obtained from the outflow tract of the right ventricle during apical pacing in 20 patients with coronary artery disease. The electrical restitution was studied by interpolation of extrasystoles with various coupling intervals to the preceding steady-state beat at basic paced cycle lengths (CL) of 700, 600, and 500 msec. At higher frequencies the ventricular effective refractory periods (V-ERP) and duration of MAPs became shorter and the electrical restitution curves were displaced downwards (P less than 0.001). With increasing diastolic intervals preceding the extrasystole up to a maximum of 100 msec, the duration of premature MAPs increased at all frequencies. An obvious hump of the electrical restitution curve was observed at coupling intervals of 100 msec due to a later transient decrease (P less than 0.01) in duration of MAPs at the basic CL of 500 msec. No significant hump was observed at lower heart rates. Thus, a different time course of the electrical restitution was observed at various CLs. The intraventricular conduction intervals were shorter at the shorter basic CLs when compared to the 700 msec cycles (P less than 0.05). The conduction intervals were also modified by the coupling interval between the interpolated stimulus and the preceding steady-state action potential (AP). The premature beats elicited 30 msec or earlier after refractoriness were conducted more slowly at all basic cycle lengths (P less than 0.005), and those between 60 and 150 msec after the V-ERP more rapidly (P less than 0.01) than the steady-state beats. These observations have implications for the protocols used for introducing two or more frequencies during programmed stimulation in man. Furthermore, the conduction pattern in vivo cannot be interpreted from single cell studies.

Electrophysiological mechanisms underlying rate-dependent changes of refractoriness in normal and segmentally depressed canine Purkinje fibers. The characteristics of post-repolarization refractoriness

Tissues from diseased hearts are known to exhibit post-repolarization refractoriness and rate-dependent changes of the refractory period that are often inconsistent with changes in action potential duration. To examine the electrophysiological mechanisms responsible for such rate-dependent changes of the refractory period, a narrow inexcitable zone was created by superfusing the central segments of Purkinje fibers with an "ion-free" isotonic sucrose solution. The degree of conduction impairment could be finely regulated by varying the resistance of the extracellular shunt pathway. At intermediate or low levels of block, the refractory period remained unchanged or decreased, respectively, as the rate was increased. At relatively high levels of block, however, we observed marked increases of the refractory period in response to increases in the stimulation rate. The disparity of refractoriness between normally conducting fibers and fibers exhibiting discontinuous conduction characteristics and post-repolarization refractoriness increased dramatically as a function of increasing stimulation rate. With the aid of current clamp techniques, we demonstrate that the differential behavior is due to the interplay between rate-dependent changes in the restitution of excitability at the site beyond the depressed zone secondary to changes in passive and active membrane properties and in the intensity of local circuit current provided to that site by activity generated in the segment proximal to the zone of block. Our data suggest that rate-dependent changes of refractoriness in Purkinje tissue are principally governed by attendant changes in membrane resistance.

Basic understanding of the electrophysiologic actions of antiarrhythmic drugs. Sources, sinks, and matrices of information

The author creates an intellectual framework consisting of key electrophysiologic principles, basic mechanisms of arrhythmogenesis, and important drug reactions that will allow the rational use of antiarrhythmic drugs. Basic principles have been emphasized because current understanding requires it.

Verapamil hydrochloride: pharmacological properties and role in cardiovascular therapeutics

Verapamil hydrochloride, a prototype calcium antagonist, is now marketed in the United States for the acute treatment of supraventricular tachyarrhythmias and for chronic management of vasospastic and chronic stable angina. It inhibits the slow inward channel in in the heart and blocks calcium influx in smooth muscle. Its intrinsic negative inotropic action, which is apparent in isolated tissues, is offset in vivo by peripheral vasodilation. It has a mild, noncompetitive sympathetic antagonist effect; its most important electrophysiologic action is a depression of AV nodal conduction, accounting for its effect in supraventricular tachyarrhythmias. Its hemodynamic actions are characterized by a complex interplay of changes in preload, afterload, contractility, heart rate, and coronary blood flow. It does not depress cardiac function, except in severe heart failure. The drug has a mild dilator action on coronary arteries and reverses ergonovine-induced vasoconstriction. Controlled trials have established its role in Prinzmetal's variant angina, unstable angina, and chronic stable angina. It has also been found to be effective in obstructive cardiomyopathies. The potential role of verapamil in such conditions as hypertension, cardioprotection, and Raynaud's phenomenon needs further evaluation; at present these indications have not been approved by the Food and Drug Administration. The most common side effects include constipation, skin rash, and dizziness; AV block, heart failure, and sinus arrest may occasionally be encountered, especially when ventricular function is compromised or conduction system disease is present.

Pharmacological basis for the therapeutic applications of slow-channel blocking drugs

Excitation-contraction coupling in cardiac muscle as well as in smooth muscle is mediated by the transmembrane fluxes of calcium. In the case of cardiac muscle, this transfer occurs through the slow-inward channel. Agents that selectively inhibit the myocardial slow-channel also block calcium entry in smooth muscle cells, particularly in arteries. Thus, such selective inhibitors of the slow channel, exemplified by verapamil, nifedipine, and diltiazem, produce a marked negative inotropic effect in cardiac muscle; in whole animals or in man, such a propensity is largely nullified or even reversed by the profound vasodilator effects of these compounds. The drugs known as calcium antagonists are chemically heterogeneous and they may exhibit associated pharmacological properties such as noncompetitive sympathetic inhibition while having varying potencies for inhibiting the calcium influx in smooth muscle and in the heart and nodal tissues. These similarities and differences influence the net electrophysiologic and hemodynamic effects of calcium antagonists in man. Electrophysiologically, the main effect is a depressant one on the AV node in which most agents of the class lengthen AV conduction and enhance refractoriness, a property that is relevant in the termination of PSVT and to the slowing of the ventricular response in atrial flutter and fibrillation. The effective refractory periods of atrial, ventricular, and His-Purkinje tissues or the bypass tracts are not altered by calcium antagonists, but conduction may be improved in ischemic tissues. On the surface ECG, the only effect is the short-term lengthening of the PR interval with no change in the QRS or Q-Tc intervals. The sinus frequency is variably affected relative to the competing influences of the direct effect, reflex response to hypotension and of sympathetic antagonism. The sinus node recovery time is affected little normally, but may be prolonged dramatically in the sick sinus syndrome. Hemodynamically, as a class of drugs, calcium antagonists produce a complex interplay of simultaneous changes in preload, afterload, contractility, coronary flow, and heart rate. The net hemodynamic effect that becomes apparent will be dependent on the agent used, on the cardiac condition and the level of ventricular function present, on the intactness of the autonomic nervous system, and on the route of drug administration. An appreciation of the electrophysiological and hemodynamic actions of calcium antagonists relative to their individual pharmacologic properties permits the rational choice of the appropriate agent in the control of a wide spectrum of cardiocirculatory disorders.

Effects of hypoxia on passive electrical properties of canine ventricular muscle

The effect of hypoxia, either in the presence or in the absence of glucose, on the passive electrical properties of canine ventricular muscle fibers was examined, employing a single sucrose gap method. The significant changes after 30 min of hypoxia (PO2 = 35-45 mm Hg) were an increase in the specific internal longitudinal resistance (Ri) and a decrease in the space constant (lambda). The values during the control (PO2 greater than 450 mm Hg) were 198 +/- 77 omega cm for Ri and 0.81 +/- 0.15 mm for lambda, and they changed to 245 +/- 90 omega cm and 0.70 +/- 0.10 mm, respectively, after 30 min of hypoxia. Hypoxia decreased the specific membrane resistance (Rm), but the changes were not statistically significant. The membrane time constant (tau m) and capacity (Cm) were not affected significantly. The absence of glucose during hypoxia was found to cause more profound changes than hypoxia alone in the passive electrical properties, especially Ri and lambda, suggesting that glucose might counteract the effects of hypoxia on these parameters of ventricular muscles.

Initiation of sustained ventricular tachyarrhythmias in a canine model of chronic myocardial infarction: importance of the site of stimulation

The importance of the site of stimulation to the initiation of sustained ventricular tachyarrhythmias was determined in 24 adult mongrel dogs. Studies were performed 3-30 days after two-stage occlusion of the mid- or distal left anterior descending coronary artery, modified by a reperfusion stage. Unipolar cathodal stimuli of twice-threshold intensity and 2 msec duration were introduced at five to 24 sites in each dog in the distribution of occluded and nonoccluded vessels. Strength-interval curves were constructed from 232 measurements at these sites and local properties of excitability and refractoriness were correlated with the ability to initiate arrhythmias. All dogs had sustained ventricular tachyarrhythmias inducible from at least one site. Intramyocardial sites with normal excitability and refractoriness within 2 cm of an area of infarction were most often successful (27 of 44, 61%) in the initiation of sustained arrhythmias. Less successful sites included normal left ventricular plunge electrode sites less than 2 cm from an area of infarction (eight of 32, 25%) (p = 0.002), left ventricular plunge electrode sites within an area of infarction (20 of 103, 19%) (p less than 0.001), normal right ventricular sites (five of 24, 21%) (p less than 0.001), and endocardial catheter sites (six of 29, 21%), (p less than 0.001). These findings suggest that local properties of excitability and refractoriness at the site of stimulation, as well as anatomic and geometric factors, may be critical in the initiation of sustained ventricular tachyarrhythmias using the technique of programmed electrical stimulation.

Junctional resistance and action potential delay between embryonic heart cell aggregates

Spheroidal aggregates of embryonic chick ventricle cells were brought into contact and allowed to synchronize their spontaneous beats. Action potentials were recorded with both intracellular and extracellular electrodes. The degree of electrical interaction between the newly apposed aggregates was assessed by measuring the delay or latency (L) between the entrained action potentials, and by determining directly interaggregate coupling resistance (Rc) with injected current pulses. Aggregate size, contact area between the aggregates, and extracellular potassium concentration (Ko+) were important variables regulating the time-course of coupling. When these variables were controlled, L and Rc were found to be linearly related after beat synchrony was achieved. In 4.8 mM Ko+ L/Rc = 3.7 ms/M omega; in 1.3 mM Ko+ L/Rc = 10.1 ms/M omega. We conclude that action potential delay between heart cell aggregates can be related quantitatively to Rc.

Strength-interval relation in the human ventricle: effect of procainamide

The effects of procainamide on strength-interval relations were evaluated in 18 patients. At plasma concentrations of 4.3 to 13.6 micrograms/ml procainamide had minimal effects on threshold current in late diastole, but in early diastole it shifted the strength-interval curve to the right. The basic strength-interval relation (that is, decreasing refractory period as current is increased) was not altered. The control refractory period decreased by a mean of 44 ms as the current was increased from threshold to 10 mA, whereas a mean decrease of 42 ms was observed after procainamide. However, the steep portion of the strength-interval curve(absolute refractory period) was shifted to longer coupling intervals by a mean value of 24 ms. These findings suggest that procainamide may primarily affect active membrane properties, but exert little net effect on passive membrane properties late in diastole.