Voltage-clamp studies on the canine Purkinje strand

Continuous-time control of alternans in long Purkinje fibers

Alternans-an arrhythmic response of cardiac tissue to periodic pacing-often serves as a precursor to a more dangerous, and potentially lethal, state of fibrillation. Suppression of alternans using feedback control may be a plausible method to prevent fibrillation. Several approaches based on impulsive control have been proposed previously, where feedback is applied for a brief instance of time during each pacing interval. This paper presents a continuous-time approach, where feedback current is applied at all times, which is capable of suppressing alternans in fibers of significantly greater length (up to at least 4 cm), compared with impulsive control (less than 1 cm), and for a wide range of pacing cycle lengths.

Transmural gradients in Na/K pump activity and [Na+]I in canine ventricle

There are well-documented differences in ion channel activity and action potential shape between epicardial (EPI), midmyocardial (MID), and endocardial (ENDO) ventricular myocytes. The purpose of this study was to determine if differences exist in Na/K pump activity. The whole cell patch-clamp was used to measure Na/K pump current (I(P)) and inward background Na(+)-current (I(inb)) in cells isolated from canine left ventricle. All currents were normalized to membrane capacitance. I(P) was measured as the current blocked by a saturating concentration of dihydro-ouabain. [Na(+)](i) was measured using SBFI-AM. I(P)(ENDO) (0.34 +/- 0.04 pA/pF, n = 17) was smaller than I(P)(EPI) (0.68 +/- 0.09 pA/pF, n = 38); the ratio was 0.50 with I(P)(MID) being intermediate (0.53 +/- 0.13 pA/pF, n = 19). The dependence of I(P) on [Na(+)](i) or voltage was essentially identical in EPI and ENDO (half-maximal activation at 9-10 mM [Na(+)](i) or approximately -90 mV). Increasing [K(+)](o) from 5.4 to 15 mM caused both I(P)(ENDO) and I(P)(EPI) to increase, but the ratio remained approximately 0.5. I(inb) in EPI and ENDO were nearly identical ( approximately 0.6 pA/pF). Physiological [Na(+)](i) was lower in EPI (7 +/- 2 mM, n = 31) than ENDO (12 +/- 3 mM, n = 29), with MID being intermediate (9 +/- 3 mM, n = 22). When cells were paced at 2 Hz, [Na(+)](i) increased but the differences persisted (ENDO 14 +/- 3 mM, n = 10; EPI 9 +/- 2 mM, n = 10; and MID intermediate, 11 +/- 2 mM, n = 9). Based on these results, the larger I(P) in EPI appears to reflect a higher maximum turnover rate, which implies either a larger number of active pumps or a higher turnover rate per pump protein. The transmural gradient in [Na(+)](i) means physiological I(P) is approximately uniform across the ventricular wall, whereas transporters that utilize the transmembrane electrochemical gradient for Na(+), such as Na/Ca exchange, have a larger driving force in EPI than ENDO.

Predicting the relative efficacy of shock waveforms for transthoracic defibrillation in dogs

STUDY OBJECTIVE

Previous work has shown that a passive membrane model using a parallel resistor-capacitor circuit is capable of predicting optimal waveforms for transvenous defibrillation. This study tested the ability of that model to predict optimal waveforms for transthoracic defibrillation.

METHODS

This study was divided into 3 parts, each of which determined transthoracic defibrillation thresholds (DFTs) in 6 dogs for several different waveform shapes and durations. For each part, strength-duration relationships were determined from both experimental and model data and then compared with test model predictions. Part 1 DFTs were determined at various durations for 3 different monophasic waveforms-the ascending ramp, descending ramp, and square waveform. Part 2 DFTs were determined for 3 biphasic waveforms. Phase 1 was a 30-ms ascending ramp, and phase 2 was an ascending ramp, a descending ramp, or a square waveform. Part 3 DFTs were determined for 3 biphasic waveforms with very short second-phase durations. Phase 1 was a 30-ms ascending ramp, and phase 2 was a descending ramp.

RESULTS

For part 1, the model was able to predict the relative defibrillation efficacy of the 3 monophasic waveforms ( P < .05). For parts 2 and 3, the model was able to predict the biphasic waveforms with the lowest DFTs. These predictions were based on the criterion that the model response at the end of the second phase should return to or slightly pass the model response value at the beginning of the first phase.

CONCLUSION

The resistor-capacitor model successfully predicted the relative defibrillation efficacy of several different waveforms delivered transthoracically.

Computer simulations of activation in an anatomically based model of the human ventricular conduction system

Simulations of the electrical activity during excitation were performed in an anatomically based model of the human ventricular conduction system. Each of the 33,000 elements of this model represented a unit bundle of Purkinje or atrioventricular nodal tissue. The Ebihara-Johnson model for sodium defined the active membrane characteristics. Using a combination of new and existing modeling techniques, simulations of excitation were completed in approximately 5 min CPU time on an IBM 3090 at the Cornell National Supercomputer Facility. Activation times at sites in the model were compared to experimental measurements for the excitation of the ventricular myocardium on the endocardial surface. These "literature-based" times were estimated from a number of reported human heart mapping studies. Initially, the times fit poorly. The major factor for the discrepancy was the conduction velocities of the elements, which were a result of the physical and electrical parameters derived from a review of histologic and electrical properties studies. In addition, there was a latency between activation of the system in the left ventricle of the model and that in the right ventricle when compared to the experimental work. When the times were scaled to adjust for the conduction velocity and ventricular latency effects, the match between the simulation and literature-based times was much improved. Quantitative comparison between normalized times resulted in correlation coefficients CCF = 0.76 for the right ventricle and CCF = 0.64 for the left ventricle.

Electrical properties of canine subendocardial Purkinje fibers surviving in 1-day-old experimental myocardial infarction

The passive electrical properties of subendocardial Purkinje fibers surviving in infarcted regions of canine ventricle 24 hours after coronary ligation were studied by using microelectrode techniques and cable theory. In normal hearts, cells within the subendocardial Purkinje fiber strands were found to be well coupled to each other but electrically isolated from neighboring myocardium. Voltage response to intracellular current injection was consistent with one-dimensional cable behavior and yielded estimates of passive electrical properties in general agreement with previous work on free-running Purkinje strands (membrane length constant, 1.2 +/- 0.1 mm; membrane time constant, 7.3 +/- 0.8 msec; input resistance, 67.4 +/- 7.4 K omega; membrane resistance, 8.2 +/- 0.7 K omega.cm; axial resistance, 0.52 +/- 0.06 M omega/cm; membrane capacitance, 960 +/- 102 nF/cm) (n = 21). On the day after coronary ligation, subendocardial Purkinje fiber action potentials were prolonged and slightly depolarized. Significant increases were measured in input resistance (+40.5%), membrane resistance (+43.9%), and axial resistance (+47.5%), whereas membrane capacitance was found to be significantly decreased (-24.3%) (n = 19). Conduction velocity, membrane length constant, membrane time constant, and the time constant and capacitance for the foot of the action potential remained unchanged. These results are consistent with electrical uncoupling between adjacent cells, which will increase internal resistivity, accompanied by changes in cellular phospholipid content, which can increase membrane resistance and alter membrane capacitance. Alternatively, the results can be explained by a simple model in which the apparent electrical structure is altered by changes in electrical coupling alone, with specific electrical properties remaining constant. Although the mechanisms underlying the observed changes remain uncertain, the present study indicates that myocardial infarction is associated with alterations in the passive electrical structure of surviving subendocardial Purkinje fibers, which, together with changes in action potential configuration, may provide a substrate for the generation of ventricular arrhythmias 24 hours after coronary ligation.

Properties of an electrogenic sodium-potassium pump in isolated canine Purkinje myocytes

1. Purkinje myocytes were isolated from canine Purkinje strands by collagenase exposure and gentle trituration. The myocytes were studied by a switched single-micro-electrode voltage-clamp technique at 37 degrees C in Tyrode solution containing 8 mM-K+ and 2 mM-Ca2+. 2. The dose-response relation for the cardiotonic steroid dihydroouabain (DHO) was obtained by measuring the change in membrane current caused by application of concentrations of 1-100 microM. The KD obtained in fourteen experiments was 3.7 +/- 1.1 microM (mean +/- S.E. of mean). 3. We employed 100 microM-DHO (a concentration more than 25-fold greater than the KD) to estimate the resting pump current (Ip) in the isolated myocytes. A value of 0.27 +/- 0.02 microA microF-1 (mean +/- S.E. of mean, n = 32) was obtained. 4. Myocytes were also exposed to K+-free solution for a period of 200 s. On return to K+-containing Tyrode solution there was a slowly decaying outward current. The time constant of decay of this pump current transient was 87 +/- 8 s (mean +/- S.E. of mean, n = 8). The integral beneath this transient was used to obtain a second estimate of the resting pump current. In four preparations where exposures in DHO and in K+-free solutions were employed the ratio Ip, DHO/Ip, K-free was 1.76 +/- 0.15 (mean +/- S.E. of mean). 5. From the magnitude of resting pump current, in the presence of total pump blockade the Na+ activity should rise at a rate of 1.3 mM min-1. 6. Reducing [K+]o from 8 to 1 mM reduced Ip by more than 40% initially. Ip then slowly increased over the next 30 min. These results suggest that the steady-state inward background current is not greatly altered by changes in [K+]o, and that [Na+]i rises to a new level. The changes in Ip obtained at early times following reduction of [K+]o to 1 or 0.5 mM (t less than 1.75 min) were used to estimate the Km for external K+; a value of 0.8 mM was obtained. 7. The results suggest that the properties of the Na+-K+ pump in isolated canine Purkinje myocytes are similar to those in canine Purkinje strands. This argues against major distortions of measured pump properties in the canine Purkinje strand and for the physiological state of the Na+-K+ pump in the isolated Purkinje myocyte.

Effects of thallium on membrane currents at diastolic potentials in canine cardiac Purkinje strands

A two-micro-electrode voltage-clamp technique was used to record membrane currents from canine cardiac Purkinje strands during hyperpolarizing steps to potentials between -70 and -150 mV in Tyrode solutions containing K+ and/or Tl+. Complete replacement of external K+ by equimolar Tl+ increases the instantaneous inwardly rectifying current. The inwardly rectifying region of the instantaneous I-V relation is shifted to more positive potentials and its slope is increased. The diastolic time-dependent current is reduced or reversed. Partial substitution of equimolar Tl+ for K+ reduces the diastolic time-dependent current. The instantaneous I-V relation is shifted inward for molar fractions of Tl+ (YTl) greater than 0.5, and is slightly more inward or unchanged for YTl less than or equal to 0.5. Addition of small amounts of Tl+ shifts the instantaneous I-V relation inward and reduces the diastolic time-dependent current. Addition of Tl+ in solutions containing Ba2+ to block the background inward rectifier has no effect on the instantaneous I-V relation; the diastolic time-dependent (pace-maker) current is reduced. Block of the pace-maker current by Tl+ is largely independent of potential in Ba2+ Tyrode solution. Since Tl+ has opposite effects on the pace-maker current and the inward rectifier, these findings support other evidence that the pace-maker current is not part of the background inward rectifier.

Gating of delayed rectification in acutely isolated canine cardiac Purkinje myocytes. Evidence for a single voltage-gated conductance

Studies of time-dependent, plateau outward current (delayed rectification) in the heart are complicated by the accumulation and depletion of K+ ions in intercellular clefts. To minimize this problem, we studied delayed rectification in acutely isolated (enzymic solution, gentle agitation) canine cardiac Purkinje myocytes using the single microelectrode voltage-clamp technique. We found a sigmoidal voltage-dependence for activation of outward plateau current, with maximal activation occurring at potentials near -10 mV. The activation and deactivation of plateau outward current was adequately described as the sum of a fast and slow exponential component. A comparison of the time course of activation of plateau outward current and the "envelope" of tail currents suggests that a single voltage-gated conductance with one open and two closed states can account for delayed rectification in Purkinje myocytes. These results differ from those previously obtained with intact sheep Purkinje fibers in which two time-dependent conductances were postulated to account for delayed rectification (Noble, D., and R. W. Tsien, 1969, J. Physiol. (Lond.), 200:205-231).

Extracellular [K+] fluctuations in voltage-clamped canine cardiac Purkinje fibers

Membrane currents and extracellular [K+] were measured in canine Purkinje strands during voltage-clamp steps to plateau or diastolic potentials. Extracellular [K+] increased during step depolarizations and decreased during step hyperpolarizations. On hyperpolarization, the largest fraction of the K+ depletion occurred during the initial 500 ms of the voltage-clamp step and was correlated with a potassium depletion current, the id. A slower component of the depletion also occurred on hyperpolarization and had a time constant consistent with cylindrical diffusion of potassium within the Purkinje strands. On depolarization, there is an accumulation of K+ that is correlated with the plateau current ix. On termination of depolarizing test pulses, the K+ accumulation decays with a time course similar to the ix tail current. Surprisingly, no accumulation of K+ occurred during the arrhythmogenic transient inward current, TI, suggesting that the selectivity of this current should be reevaluated.

Membrane current following activity in canine cardiac Purkinje fibers

Membrane current following prolonged periods of rapid stimulation was examined in short (less than 1.5 mm) canine cardiac Purkinje fibers of radius less than 0.15 mm. The Purkinje fibers were repetitively stimulated by delivering trains of depolarizing voltage clamp pulses at rapid frequencies. The slowly decaying outward current following repetitive stimulation ("post-drive" current) is eliminated by the addition of 10(-5) M dihydro-ouabain. The post-drive current is attributed to enhanced Na/K exchange caused by Na loading during the overdrive. Depolarizing voltage clamp pulses initiated from negative (-80 mV) or depolarized (-50 mV) holding potentials can give rise to post-drive current because of activation of tetrodotoxin-sensitive or D600-sensitive channels. The magnitude of the post-drive current depends on the frequency of voltage clamp pulses, the duration of each pulse, and the duration of the repetitive stimulation. The time constant of decay of the post-drive current depends on extracellular [K] in accordance with Michaelis-Menten kinetics. The Km is 1.2 mM bulk [K], [K]B. The mean time constant in 4 mM [K]B is 83 s. Epinephrine (10(-5) M) decreases the time constant by 20%. The time constant is increased by lowering [Ca]o between 4 and 1 mM. Lowering [Ca]o further, to 0.1 mM, eliminates post-drive current following repetitive stimulation initiated from depolarized potentials. The latter result suggests that slow inward Ca2+ current may increase [Na]i via Na/Ca exchange.

Slow inactivation of a tetrodotoxin-sensitive current in canine cardiac Purkinje fibers

We used the two-microelectrode voltage clamp technique and tetrodotoxin (TTX) to investigate the possible occurrence of slow inactivation of sodium channels in canine cardiac Purkinje fibers under physiologic conditions. The increase in net outward current during prolonged (5-20 s) step depolarizations (range -70 to +5 mV) following the application of TTX is time dependent, being maximal immediately following depolarization, and declining thereafter towards a steady value. To eliminate the possibility that this time-dependent current was due to inadequate voltage control of these multicellular preparations early during square clamp pulses, we also used slowly depolarizing voltage clamp ramps (range 5-100 mV/s) to ensure control of membrane potential. TTX-sensitive current also was observed with these voltage ramps; the time dependence of this current was demonstrated by the reduction of the peak current magnitude as the ramp speed was reduced. Reducing the holding potential within the voltage range of sodium channel inactivation also decreased the TTX-sensitive current observed with identical speed ramps. These results suggest that the TTX-sensitive time-dependent current is a direct measure of slow inactivation of canine cardiac sodium channels. This current may play an important role in modulating the action potential duration.

Use-dependent block of cardiac sodium channels by quaternary derivatives of lidocaine

Modulation of the reduction of fast inward sodium current by local anesthetics due to changes in electrical activity has been termed use-dependent block ( Courtney 1975). To determine the mechanisms responsible for use-dependent block of cardiac sodium channels and to compare use-dependent block in cardiac and nerve preparations, we investigated use-dependent block of cardiac sodium channels by the quaternary lidocaine analogues QX -314 and QX -222 (two agents previously studied in nerve). We used canine cardiac Purkinje fibers, and assessed changes in the fast inward sodium current using changes in the maximum rate of rise of the action potential upstroke (Vmax). Two microelectrode voltage clamp and current clamp techniques were used to control membrane potential prior to stimulated upstrokes . Use-dependent block was not affected by shortening the action potential duration during rapid stimulation. Partial recovery from use-dependent block was observed during rapid stimulation with brief depolarizing prepulses terminating immediately prior to the upstroke. Similar prepulses also prevented the development of use-dependent block following an abrupt increase in the stimulation rate. Hyperpolarizing prepulses during rapid stimulation caused recovery from use-dependent block; recovery was greater and more rapid with increasingly negative prepulses . Hyperpolarization during periods of electrical quiescence also caused greater recovery. These results, interpreted using the modulated receptor hypothesis ( Hille 1977; Hondeghem and Katzung 1977), suggest that use-dependent block of cardiac sodium channels by quaternary local anesthetics is due to drug association with the inactivated sodium channel receptor which occurs only after these drugs gain access to the receptor site through open sodium channels.

The influence of molecular form of local anesthetic-type antiarrhythmic agents on reduction of the maximum upstroke velocity of canine cardiac Purkinje fibers

We studied the local anesthetic effects of the quaternary lidocaine analogues QX-314, QX-572, and QX-222, the tertiary amine lidocaine, its analogues tocainide, 6603, 6211, and the neutral local anesthetic benzocaine to determine if molecular charge of antiarrhythmic agents influences their local anesthetic effects on heart fibers. We used standard microelectrode techniques and canine cardiac Purkinje fibers to compare the effects of stimulation rate, drug concentration, and K+-induced changes in resting membrane potential on the reduction of fast inward sodium current using the maximum rate of rise of the action potential upstroke, Vmax, as an index of changes in peak sodium current. Use-dependent block, defined as a modulation of the reduction in Vmax by local anesthetics due to changes in the stimulation rate, was observed with the permanently charged analogues and was most prominent for agents existing predominantly in the charged form, but was absent for the neutral local anesthetic benzocaine. The development of use-dependent block during rapid stimulation preceded by prolonged periods of quiescence was an exponential process which became more rapid with increasing drug concentration. Recovery from use-dependent block during quiescence was an exponential process that was not influenced by similar drug concentration changes. All local anesthetics caused tonic block, defined as a drug-induced reduction of Vmax from control that attained a constant value at slow stimulation rates (cycle length range 15 seconds to 2 minutes) and was not changed by prolonged (up to 8 minutes) periods of quiescence. These findings suggest that the charged form of lidocaine and its analogues is responsible for use-dependent block of cardiac sodium channels.

The ultrastructure of the cardiac Purkinje strand in the dog: a morphometric analysis

Purkinje strands from both ventricles of adult mongrel dogs were excised, and electrical properties were studied by the voltage-clamp technique. The strands were then examined with light and electron microscopy and structural properties were analysed by morphometric techniques. The canine Purkinje strand contains (by volume) about 28% myocyte and 55% dense outer connective tissue. The remainder of the volume is taken up by the inner shell of loosely packed connective tissue within 10 microns of a myocyte membrane. These volume fractions vary considerably from one strand to another. Clefts less than 10 microns wide occupy 18% of the myocyte volume and clefts less than 1 micron wide occupy 1%. The membrane surface area of the myocytes can be divided into three categories by reference to the size of the adjacent cleft. About 47.8% of the membrane surface area faces clefts wider than 1 micron, another 22.2% faces clefts between 0.1 and 1 micron wide, and the final 30% faces clefts less than 0.1 micron wide. The surface area facing the narrowest clefts (less than 0.1 micron wide) is divided between nexuses 3%, desmosomes 10%, and unspecialized membrane 17% (each figure is expressed as a percentage of the total surface area of myocyte membrane). The canine Purkinje strand has a more favourable anatomy than the sheep Purkinje strand for most physiological experiments. We expect that the complicating effects of series resistance and change in the concentration of extracellular ions will be much smaller than in sheep strands, but still not negligible.