Overdrive excitation and cellular calcium load in canine cardiac Purkinje fibers

Essential role of diastolic oscillatory potentials in adrenergic control of guinea pig sino-atrial node discharge

Background

The diastolic oscillatory after-potential V_os and pre-potential ThV_os play an essential role in the pacemaker mechanism of sino-atrial node (SAN). The aim of this study was to investigate whether these oscillatory potentials are also involved in adrenergic control of SAN discharge.

Methods

V_os and ThV_os were visualized by superfusing guinea pig SAN in high [K⁺]_o. The actions of adrenergic agonists on oscillatory potentials were studied by means of a microelectrode technique. Statistical significance was determined by means of Student's paired t-test.

Results

In non-spontaneous SAN, norepinephrine (NE) decreased the resting potential into a voltage range ("oscillatory zone") where increasingly larger ThV_os appeared and initiated spontaneous discharge. In slowly discharging SAN, NE gradually increased the rate by increasing the amplitude and slope of earlier-occurring ThV_os and of V_os until these oscillations fused with initial diastolic depolarization (DD₁). In the presence of NE, sudden fast rhythms were initiated by large V_os that entered a more negative oscillatory zone and initiated a large ThV_os. Recovery from NE exposure involved the converse changes. The β-adrenergic agonist isoproterenol had similar actions. Increasing calcium load by decreasing high [K⁺]_o, by fast drive or by recovery in Tyrode solution led to growth of V_os and ThV_os which abruptly fused when a fast sudden rhythm was induced. Low [Ca²⁺]_o antagonized the adrenergic actions. Cesium (a blocker of I_f) induced spontaneous discharge in quiescent SAN through ThV_os. In spontaneous SAN, Cs⁺increased V_os and ThV_os, thereby increasing the rate. Cs⁺ did not hinder the positive chronotropic action of NE. Barium increased the rate, as Cs⁺ did.

Conclusion

Adrenergic agonists: (i) initiate SAN discharge by decreasing the resting potential and inducing ThV_os; (ii) gradually accelerate SAN rate by predominantly increasing size and slope of earlier and more negative ThV_os; (iii) can induce sudden fast rhythms through the abrupt fusion of large V_os with large ThV_os; (iv) increase V_os and ThV_osby increasing cellular calcium; and (v) do not modify the oscillatory potentials by means of the hyperpolarization-activated current I_f. The results provide evidence for novel mechanisms by which the SAN dominant pacemaker activity is initiated and enhanced by adrenergic agonists.

Calcium overload and cardiac function

The changes in cardiac function caused by calcium overload are reviewed. Intracellular Ca(2+) may increase in different structures [e.g. sarcoplasmic reticulum (SR), cytoplasm and mitochondria] to an excessive level which induces electrical and mechanical abnormalities in cardiac tissues. The electrical manifestations of Ca(2+) overload include arrhythmias caused by oscillatory (V(os)) and non-oscillatory (V(ex)) potentials. The mechanical manifestations include a decrease in force of contraction, contracture and aftercontractions. The underlying mechanisms involve a role of Na(+) in electrical abnormalities as a charge carrier in the Na(+)-Ca(2+) exchange and a role of Ca(2+) in mechanical toxicity. Ca(2+) overload may be induced by an increase in [Na(+)](i) through the inhibition of the Na(+)-K(+) pump (e.g. toxic concentrations of digitalis) or by an increase in Ca(2+) load (e.g. catecholamines). The Ca(2+) overload is enhanced by fast rates. Purkinje fibers are more susceptible to Ca(2+) overload than myocardial fibers, possibly because of their greater Na(+) load. If the SR is predominantly Ca(2+) overloaded, V(os) and fast discharge are induced through an oscillatory release of Ca(2+) in diastole from the SR; if the cytoplasm is Ca(2+) overloaded, the non-oscillatory V(ex) tail is induced at negative potentials. The decrease in contractile force by Ca(2+) overload appears to be associated with a decrease in high energy phosphates, since it is enhanced by metabolic inhibitors and reduced by metabolic substrates. The ionic currents I(os) and I(ex) underlie V(os) and V(ex), respectively, both being due to an electrogenic extrusion of Ca(2+) through the Na(+)-Ca(2+) exchange. I(os) is an oscillatory current due to an oscillatory release of Ca(2+) in early diastole from the Ca(2+)-overloaded SR, and I(ex) is a non-oscillatory current due to the extrusion of Ca(2+) from the Ca(2+)-overloaded cytoplasm. I(os) and I(ex) can be present singly or simultaneously. An increase in [Ca(2+)](i) appears to be involved in the short- and long-term compensatory mechanisms that tend to maintain cardiac output in physiological and pathological conditions. Eventually, [Ca(2+)](i) may increase to overload levels and contribute to cardiac failure. Experimental evidence suggests that clinical concentrations of digitalis increase force in Ca(2+)-overloaded cardiac cells by decreasing the inhibition of the Na(+)-K(+) pump by Ca(2+), thereby leading to a reduction in Ca(2+) overload and to an increase in force of contraction.

Functional reentry's influence on intracellular calcium in the LRd membrane equations

This paper examines relationships between transmembrane potential (Vm), [Ca2+]i dependent membrane ionic currents, and [Ca2+]i handling by the sarcoplasmic reticulum (SR) in a two-dimensional model of cardiac tissue. Luo-Rudy dynamic (LRd) membrane equations were used because they include detailed formulations for triggered SR Ca2+ release dependent on membrane Ca2+ influx (CICR) and for spontaneous SR Ca2+ release following calsequestrin buffer overload (SCR). Reentry's rapid rate (110-ms cycle length) elevated [Ca2+]i and limited CICR, which in turn promoted SCR that occurred at intervals of 320-350 ms, was preferential at sites located inside the functional center, and destabilized the reentrant activation sequence. Although adjustment of LRd parameters for SR Ca2+ modified SCR interval and peak [Ca2+]i in voltage clamp simulations with a command waveform representing Vm time course within the functional center, SCR persisted. Using the same command waveform, SCR also occurred with an alternate SR Ca2+ formulation that represented subcellular details underlying CICR. LRd parameter adjustments to promote CICR and limit SCR in subsequent reentry simulations failed to eliminate SCR completely, as they modulated SCR intervals in a manner consistent with the voltage clamp simulations. Taken together, our findings support a destabilizing influence of functional reentry on [Ca2+]i handling. However, [Ca2+]i instabilities did not always fractionate depolarization wavefronts during reentry. Fractionation depended, in part, upon CICR and SCR parameters in the LRd formulation for SR Ca2+ release.

Role of Na-Ca exchange in the action potential changes caused by drive in cardiac myocytes exposed to different Ca2+ loads

The role of Na-Ca exchange in the membrane potential changes caused by repetitive activity ("drive") was studied in guinea pig single ventricular myocytes exposed to different [Ca2+]o. The following results were obtained. (i) In 5.4 mM [Ca2+]o, the action potentials (APs) gradually shortened during drive, and the outward current during a train of depolarizing voltage clamp steps gradually increased. (ii) The APs shortened more and were followed by a decaying voltage tail during drive in the presence of 5 mM caffeine; the outward current became larger and there was an inward tail current on repolarization during a train of depolarizing steps. (iii) These effects outlasted drive so that immediately after a train of APs, currents were already bigger and, after a train of steps, APs were already shorter. (iv) In 0.54 mM [Ca2+]o, the above effects were much smaller. (v) In high [Ca2+]o APs were shorter and outward currents larger than in low [Ca2+]o. (vi) In 10.8 mM [Ca2+]o, both outward and inward currents during long steps were exaggerated by prior drive, even with steps (+80 and +120 mV) at which there was no apparent inward current identifiable as ICa. (vii) In 0.54 mM [Ca2+]o, the time-dependent outward current was small and prior drive slightly increased it. (viii) During long steps, caffeine markedly increased outward and inward tail currents, and these effects were greatly decreased by low [Ca2+]o. (ix) After drive in the presence of caffeine, Ni2+ decreased the outward and inward tail currents. It is concluded that in the presence of high [Ca2+]o drive activates outward and inward Na-Ca exchange currents. During drive, the outward current participates in the plateau shortening and the inward tail current in the voltage tail after the action potential.Key words: ventricular myocytes, repetitive activity, outward and inward Na-Ca exchange currents, caffeine, nickel.

On the mechanism of cesium-induced voltage and current tails in single ventricular myocytes

The mechanisms by which different concentrations of cesium modify membrane potentials and currents were investigated in guinea pig single ventricular myocytes. In a dose-dependent manner, cesium reversibly decreases the resting potential and action potential amplitude and duration, and induces a diastolic decaying voltage tail (Vex), which increases at more negative and reverses at less negative potentials. In voltage-clamped myocytes, Cs+ increases the holding current, increases the outward current at plateau levels while decreasing it at potentials closer to resting potential, induces an inward tail current (Iex) on return to resting potential and causes a negative shift of the threshold for the inward current. During depolarizing ramps, Cs+ decreases the outward current negative to inward rectification range, whereas it increases the current past that range. During repolarizing ramps, Cs+ shifts the threshold for removal of inward rectification negative slope to less negative values. Cs+-induced voltage and current tails are increased by repetitive activity, caffeine (5 mM) and high [Ca2+]O (8.1 mM), and are reduced by low Ca2+ (0.45 mM), Cd2+ (0.2 mM) and Ni2+ (2 mM). Ni2+ also abolishes the tail current that follows steps more positive than ECa. We conclude that Cs+ (1) decreases the resting potential by decreasing the outward current at more negative potentials, (2) shortens the action potential by increasing the outward current at potentials positive to the negative slope of inward rectification, and (3) induces diastolic tails through a Ca2+-dependent mechanism, which apparently is an enhanced electrogenic Na-Ca exchange.

Overdrive Excitation in the Guinea Pig Sinoatrial Node Superfused in High [K(+)](o)

The aim of the present experiments was to study the characteristics and mechanisms of the rhythm induced by overdrive ('overdrive excitation', ODE) in the sinoatrial node (SAN) superfused in high [K(+)](o) (8-14 mM). It was found that: (1) overdrive may induce excitation in quiescent SAN and during a slow drive; (2) in spontaneously active SAN, overdrive may accelerate the spontaneous discharge; (3) immediately after the end of overdrive, a pause generally precedes the onset of the induced rhythm; (4) during the pause, an oscillatory potential (V(os)) may be superimposed on the early diastolic depolarization (DD); (5) during the subsequent late DD, a different kind of oscillatory potential appears near the threshold for the upstroke (ThV(os)) which is responsible for the initiation of spontaneous activity; (6) once started, the induced rhythm is fastest soon after overdrive; (7) faster drives induce longer and faster spontaneous rhythms; (8) the induced action potentials are slow responses followed by DD with a superimposed V(os), but ThV(os) is responsible for ODE; (9) the induced rhythm subsides when ThV(os) miss the threshold and gradually decay; (10) low [Ca(2+)](o) abolishes ODE; (11) in quiescent SAN, high [Ca(2+)](o) induces spontaneous discharge through ThV(os) and increases its rate by enhancing V(os) and shifting the threshold to more negative values, and (12) tetrodotoxin abolishes ODE as welll as the spontaneous discharge induced by high [Ca(2+)](o). In conclusion, in K(+)-depolarized SAN, ODE may be present in the apparent absence of calcium overload, is Ca(2+)- and Na(+)-dependent and is mediated by ThV(os) and not by V(os). Copyright 1997 S. Karger AG, Basel

Preliminary report: modification of cardiac contraction rate by pulsed magnetic fields

Isolated rat hearts and excised canine cardiac tissues were subjected to pulsed magnetic fields. The fields excited in coils by tandem pairings of sinusoidal pulses were presented at various inter-pair delays and repetition rates. The waveform of the magnetic field was a single or multiple sinusoid followed after a variable delay by another single or multiple sinusoid. Small but reliable increases in the beating rate of rat heart were observed. Similar increases occurred in contraction rates of canine tissues. Both preparations exhibited a contraction-rate dependency on the repetition rate of the paired magnetic pulses: 4.5-6 rep/s for canine tissue, and 20-25 and 40-55 reps/s for rat heart. Flux-density thresholds for both preparations approximated 10 mT (100 gauss) rms.

Mechanisms by which calcium modulates diastolic depolarization in sheep cardiac Purkinje fibers

The mechanisms by which calcium modulates diastolic depolarization (DD) in sheep cardiac Purkinje fibers were studied in vitro. Increasing [Ca]o from 2.7 mM to 10.8 mM increased both the slope and amplitude of DD, induced oscillatory potentials (V(os)), and prolonged depolarization (V(ex)). The steepening of DD occurred even in the absence of an obvious V(os). The increase in DD amplitude was due both to an increase in the maximum diastolic potential and to a less negative steady-state level. At constant [Ca]o, increasing the driving rate had effects similar to those induced by increasing [Ca]o. The increase in DD slope and amplitude was least at the slowest rates and leveled off at the fastest rates in high [Ca]o. Lowering [Ca]o decreased DD slope and amplitude, but spontaneous activity could be present during interruption of the drive. In slowly driven fibers, increasing [Ca]o to 10.8 mM initially shifted the maximum diastolic potential and steady state DD to more negative values, and subsequently shifted the latter (but not the former) to less negative values. On recovery, a transient depolarization occurred. Quiescent fibers exposed to high [Ca]o also underwent a transient hyperpolarization and a subsequent depolarization, whereas reciprocal effects occurred when [Ca]o was lowered. It is concluded that [Ca]o modulates DD through several different mechanisms and that most (but not all) modifications induced are brought about by changes in [Ca]i.

Strontium induces oscillatory potentials in sheep cardiac Purkinje fibers

The induction of strontium overload and its electromechanical manifestations, the factors influencing and the mechanism underlying Sr overload were studied in Purkinje fibers perfused in vitro. Strontium: (1) can induce an oscillatory potential (Vos) and repetitive spontaneous activity at low concentrations (1.35-2.7 mM); (2) at high concentrations (5.4-10.8 mM) less frequently causes a Vos but during recovery in Tyrode solution Vos appears as Sr overload recedes; (3) decreases the maximum diastolic potential by inducing a prolonged depolarization (Vex) which subsides slowly during an interruption of drive; (4) induces a larger Vex after procedures that increase Sr loading (fast driving rates, higher [Sr]o or longer action potentials); (5) does not induce Vos and Vex when the slow channel is blocked; (6) exaggerates Vex (but not Vos) in calcium overloaded fibers; (7) exchanges with Na since in low [Na]o the twitch amplitude increases; (8) is removed from the cell at the resting potential since after a period of quiescence the first resumed twitch decreases as a function of the preceding pause duration; (9) needs Na as charge carrier since the slope of diastolic depolarization decreases in low [Na]o. Thus, Sr causes overload even at low concentrations and induces an oscillatory potential and the prolonged depolarization Vex, whose mechanism appears to be an electrogenic Sr extrusion through Na-Sr exchange.

On the mechanism of overdrive suppression in the guinea pig sinoatrial node

Factors underlying overdrive suppression were studied in guinea pig sinoatrial node perfused in vitro. Overdrive (1) is followed by a short suppression and a transient decrease in maximum diastolic potential (Emax); (2) causes an immediate decrease and then a reincrease in force followed after overdrive by a transient overshoot; (3) may induce a marked suppression in high [Ca]0, which is a function of the rate and duration of overdrive and is not affected by tetrodotoxin or atropine; (4) in the presence of acetylcholine (ACh), decreases Emax and causes a longer suppression, which may be associated to a transient hyperpolarization; (5) can be initiated periodically by spontaneous beats and the cycles are abolished by calcium antagonists but not by atropine; (6) in high [Ca]0 (but not in ACh) is followed by an oscillatory potential, the amplitude of which depends of the characteristics of overdrive; (7) does not cause suppression in zero [Ca]0; (8) may cause suppression that is due to failure of conduction; and (9) may be followed by a prolonged transient hyperpolarization in the presence of ACh and Cs. Thus, the sinoatrial node, intracellular calcium accumulation enhances overdrive suppression and causes periodic suppression of spontaneous cyclic rhythms. These calcium actions are direct and not related to a potentiation of ACh effects. The elimination of diastolic depolarization by ACh and Cs reveals an overdrive-induced hyperpolarization possibly related to an electrogenic Na extrusion.

Extensive Ca2+ release from energized mitochondria induced by disulfiram

The effect of the alcohol-deterrent drug, disulfiram, on mitochondrial Ca2+ content was studied. Addition of this drug (20 microM) to mitochondria induces a complete loss of accumulated Ca2+. The calcium release is accompanied by a collapse of the transmembrane potential, mitochondrial swelling, and a diminution of the NAD(P)H/NAD(P) radio. These effects of disulfiram depend on Ca2+ accumulation; thus, ruthenium red reestablished the membrane delta psi and prevents the oxidation of pyridine nucleotides. The binding of disulfiram to the membrane sulfhydryls appeared to depend on the metabolic state of mitochondria, as well as on the mitochondrial configuration. In addition, it is shown that modification of 9 nmol -SH groups per mg protein suffices to induce the release of accumulated Ca2+.

Electrical and ionic mechanisms of early reperfusion arrhythmias in sheep cardiac Purkinje's fibers

The mechanisms of induction of early reperfusion arrhythmias were studied in sheep cardiac Purkinje's fibers superfused in vitro. Transmembrane potentials, intracellular sodium activity (aiNa), and contractile force were recorded. Stoppage of the flow of Tyrode's solution (ischemia) for 1 hour initially decreased slightly aiNa (-0.57 mmol -7.2%), increased the action potential amplitude (+6.1%) and duration (+7.8%), and decreased diastolic depolarization slope (-45.2%). As the ischemia continued, aiNa increased progressively (to 12.53 mmol, +56.2%), whereas force peaked (+395%) after about 30 minutes and then began to decrease. By the end of ischemia, there was a decrease in action potential amplitude (-14.9%) and duration (-39.6%), whereas diastolic depolarization slope reincreased again almost to control value (-7%). When the flow of Tyrode's solution was resumed (reperfusion), force markedly increased (+211.1%) and oscillatory potentials initiated arrhythmias (extrasystoles and repetitive fast discharge) in 64% of tests. Force and aiNa decreased relatively rapidly. The arrhythmias initiated after 58.4 +/- 1.8 seconds of reperfusion and lasted 101.5 +/- 3.2 seconds. When [Na]o was increased by +19.2%, reperfusion arrhythmias occurred after only 30 minutes of ischemia. Thus, in Purkinje's fibers superfused in vitro, early reperfusion arrhythmias are induced by oscillatory potentials caused by calcium overload, which is enhanced by the increase in aiNa during ischemia.

Contribution of the Na+/K+-pump to the membrane potential

The inward movement of sodium ions and the outward movement of potassium ions are passive and the reverse movements against the electrochemical gradients require the activity of a metabolism-driven Na+/K+-pump. The activity of the Na+/K+-pump influences the membrane potential directly and indirectly. Thus, the maintenance of a normal electrical function requires that the Na+/K+-pump maintain normal ionic concentrations within the cell. The activity of the Na+/K+-pump also influences the membrane potential directly by generating an outward sodium current that is larger when the Na+/K+-pump activity is greater. The activity of the Na+/K+-pump is regulated by several factors including the intracellular sodium concentration and the neuromediators norepinephrine and acetylcholine. The inhibition of the Na+/K+-pump can lead indirectly to the development of inward currents that may cause repetitive activity. Therefore, the Na+/K+-pump modifies the membrane potential in different ways both under normal and abnormal conditions and influences in an essential way many cardiac functions, including automaticity, conduction and contraction. Key words. Active transport of ions; cardiac tissues; electroneutral and electrogenic Na+/K/-pump; control of Na+/K+-pump; normal and abnormal electrical events.

On the mechanisms underlying cardiac standstill: factors determining success or failure of escape pacemakers in the heart

The mechanisms underlying cardiac standstill in health and disease are considered. Ventricular standstill results from failure of impulse formation or transmission in the ventricles. In the healthy heart, idioventricular automaticity is not brought into play and instead is suppressed by the sinus node by virtue of its faster rate (overdrive suppression). However, should the sinus node activity be suppressed or atrioventricular (AV) conduction blocked, overdrive suppression no longer persists. For this reason, the ventricular pacemakers activate the ventricles at a slow rate and under the regulatory activity of the sympathetic system. In the diseased heart, the idioventricular pacemakers or the regulatory mechanism can be altered structurally or functionally. This can be the result of the disease, compensatory mechanisms or therapeutic interventions. Disease may affect the idioventricular pacemakers directly or indirectly through anoxia, a change in ionic environment or an alteration of sympathetic innervation. Compensatory mechanisms may affect reflex actions, blood supply or heart rate. Drug administration may alter autonomic balance, block the action of neuromediators on their receptors or modify diastolic depolarization or its ability to attain the threshold. Because of these different direct and indirect actions, a sudden cessation of sinus node activity or sudden AV block may result in the diseased heart in a prolonged and even fatal cardiac standstill, especially if the tolerance to ischemia of other organs (notably the brain) is decreased.