Effects of caffeine on intracellular sodium activity in cardiac Purkinje fibres: relation to force

On the mechanisms underlying diastolic voltage oscillations in the sinoatrial node

AIM

The study of the mechanisms underlying the oscillatory afterpotential (V(os)) and prepotential (ThV(os)).

BACKGROUND

It has been recently shown that V(os) and ThV(os) play an obligatory role in the dominant sinoatrial node (SAN) discharge.

METHODS

Guinea pig isolated SAN was studied in vitro by means of a microelectrode technique.

RESULTS

High [K(+)](o) and premature stimuli unmask V(os) superimposed on early diastolic depolarization and ThV(os) within a less negative voltage range ("oscillatory zone"). Subthreshold stimuli elicit ThV(os) in the oscillatory zone, but not at more negative values. Drive and caffeine shift the oscillatory zone in a negative direction. Low caffeine concentrations increase the size of V(os) and of ThV(os), rate, and force. High caffeine concentrations suppress V(os) but increase the size of ThV(os) and shift them to more negative values until they eventually miss the threshold. In quiescent SAN in high caffeine, a fast drive enhances ThV(os) size, thereby initiating a transient spontaneous rhythm ("overdrive excitation"). Adrenergic agonists potentiate caffeine-induced overdrive excitation through an increase in ThV(os). In high caffeine, the first twitch after quiescence is not larger, twitch relaxation is slower, V(os) is abolished, and the prolonged nonoscillatory afterdepolarization V(ex) is induced, consistent with an impairment of Ca2+ handling by the sarcoplasmic reticulum. The effects of caffeine in Tyrode's solution are accounted for by the caffeine-induced changes in the oscillatory potentials. Tetrodotoxin decreases force and size of both V(os) and ThV(os).

CONCLUSIONS

The mechanism underlying V(os) is related to a diastolic release of Ca2+ from a Ca2+-overloaded sarcoplasmic reticulum, whereas that of ThV(os) appears to be related to ionic currents in the resting potential range that can initiate and sustain spontaneous discharge.

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.

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.