Cytochalasin D as excitation-contraction uncoupler for optically mapping action potentials in wedges of ventricular myocardium

Synchronized Cardiac Impulses Emerge From Heterogeneous Local Calcium Signals Within and Among Cells of Pacemaker Tissue

OBJECTIVES

This study sought to identify subcellular Ca²⁺ signals within and among cells comprising the sinoatrial node (SAN) tissue.

BACKGROUND

The current paradigm of SAN impulse generation: 1) is that full-scale action potentials (APs) of a common frequency are initiated at 1 site and are conducted within the SAN along smooth isochrones; and 2) does not feature fine details of Ca²⁺ signaling present in isolated SAN cells, in which small subcellular, subthreshold local Ca²⁺ releases (LCRs) self-organize to generate cell-wide APs.

METHODS

Immunolabeling was combined with a novel technique to detect the occurrence of LCRs and AP-induced Ca²⁺ transients (APCTs) in individual pixels (chronopix) across the entire mouse SAN images.

RESULTS

At high magnification, Ca²⁺ signals appeared markedly heterogeneous in space, amplitude, frequency, and phase among cells comprising an HCN4⁺/CX43^- cell meshwork. The signaling exhibited several distinguishable patterns of LCR/APCT interactions within and among cells. Rhythmic APCTs that were apparently conducted within the meshwork were transferred to a truly conducting HCN4^-/CX43⁺ network of striated cells via narrow functional interfaces where different cell types intertwine, that is, the SAN anatomic/functional unit. At low magnification, the earliest APCT of each cycle occurred within a small area of the HCN4 meshwork, and subsequent APCT appearance throughout SAN pixels was discontinuous and asynchronous.

CONCLUSIONS

The study has discovered a novel, microscopic Ca²⁺ signaling paradigm of SAN operation that has escaped detection using low-resolution, macroscopic tissue isochrones employed in prior studies: synchronized APs emerge from heterogeneous subcellular subthreshold Ca²⁺ signals, resembling multiscale complex processes of impulse generation within clusters of neurons in neuronal networks.

Non-signalling energy use in the developing rat brain

Energy use in the brain constrains its information processing power, but only about half the brain's energy consumption is directly related to information processing. Evidence for which non-signalling processes consume the rest of the brain's energy has been scarce. For the first time, we investigated the energy use of the brain's main non-signalling tasks with a single method. After blocking each non-signalling process, we measured oxygen level changes in juvenile rat brain slices with an oxygen-sensing microelectrode and calculated changes in oxygen consumption throughout the slice using a modified diffusion equation. We found that the turnover of the actin and microtubule cytoskeleton, followed by lipid synthesis, are significant energy drains, contributing 25%, 22% and 18%, respectively, to the rate of oxygen consumption. In contrast, protein synthesis is energetically inexpensive. We assess how these estimates of energy expenditure relate to brain energy use in vivo, and how they might differ in the mature brain.

Technical advances in studying cardiac electrophysiology - Role of rabbit models

Cardiovascular research has made a major contribution to an unprecedented 10 year increase in life expectancy during the last 50 years: most of this increase due to a decline in mortality from heart disease and stroke. The majority of the basic cardiovascular science discoveries, which have led to this impressive extension of human life, came from investigations conducted in various small and large animal models, ranging from mouse to pig. The small animal models are currently popular because they are amenable to genetic engineering and are relatively inexpensive. The large animal models are favored at the translational stage of the investigation, as they are anatomically and physiologically more proximal to humans, and can be implanted with various devices; however, they are expensive and less amenable to genetic manipulations. With the advent of CRISPR genetic engineering technology and the advances in implantable bioelectronics, the large animal models will continue to advance. The rabbit model is particularly poised to become one of the most popular among the animal models that recapitulate human heart diseases. Here we review an array of the rabbit models of atrial and ventricular arrhythmias, as well as a range of the imaging and device technologies enabling these investigations.

Optical Imaging of Cardiac Action Potential

This chapter reviews the major milestones and scientific achievements facilitated by optical imaging of the action potential in the heart over more than four decades since its introduction. We discuss the limitations of this technique, which sometimes are not fully recognized; the unresolved issues, such as motion artifacts, and the newest developments and future directions.

The effects of remodeling with heart failure on mode of initiation of ventricular fibrillation and its spatiotemporal organization

PURPOSE

The effect of the heart failure substrate on the initiation of ventricular fibrillation (VF) and its resulting mechanism is not known. The objective of this study was to determine the effects of substrate on VF initiation and its spatiotemporal organization in the heart failure model.

METHODS

Optical action potentials were recorded from LV wedge preparations either from structurally normal hearts (control, n = 11) or from congestive heart failure (CHF; n = 7), at the epicardial surface, endocardial surface which included a papillary muscle, and a transmural cross section. Action potential duration (APD(80)) was determined, and VF was initiated. A fast Fourier transform was calculated, and the dominant frequency (DF) was determined.

RESULTS

The CHF group showed increased VF vulnerability (69 vs 26 %, p < 0.03), and every mapped surface showed an APD(80) gradient which included islands of higher APDs on the transmural surface (M cells) which was not observed in controls. VF in the CHF group was characterized by stable, discrete, high-DF areas that correlated to either foci or spiral waves located on the transmural surface at the site of the papillary muscle. Overall, the top 10 % of DFs correlated to an APD of 101 ms while the bottom 10 % of DFs correlated to an APD of 126 ms (p < 0.01).

CONCLUSIONS

In the CHF model, APD gradients correlated with an increased vulnerability to VF, and the highest stable DFs were located on the transmural surface which was not seen in controls. This indicates that the CHF substrate creates unique APD and DF characteristics.

An automated system using spatial oversampling for optical mapping in murine atria. Development and validation with monophasic and transmembrane action potentials

We developed and validated a new optical mapping system for quantification of electrical activation and repolarisation in murine atria. The system makes use of a novel 2nd generation complementary metal-oxide-semiconductor (CMOS) camera with deliberate oversampling to allow both assessment of electrical activation with high spatial and temporal resolution (128 × 2048 pixels) and reliable assessment of atrial murine repolarisation using post-processing of signals. Optical recordings were taken from isolated, superfused and electrically stimulated murine left atria. The system reliably describes activation sequences, identifies areas of functional block, and allows quantification of conduction velocities and vectors. Furthermore, the system records murine atrial action potentials with comparable duration to both monophasic and transmembrane action potentials in murine atria.

Characterization of radiofrequency ablation lesion development based on simulated and measured intracardiac electrograms

Radiofrequency ablation (RFA) therapy is the gold standard in interventional treatment of many cardiac arrhythmias. A major obstacle is nontransmural lesions, leading to recurrence of arrhythmias. Recent clinical studies have suggested intracardiac electrogram (EGM) criteria as a promising marker to evaluate lesion development. Seeking for a deeper understanding of underlying mechanisms, we established a simulation approach for acute RFA lesions. Ablation lesions were modeled by a passive necrotic core surrounded by a borderzone with properties of heated myocardium. Herein, conduction velocity and electrophysiological properties were altered. We simulated EGMs during RFA to study the relation between lesion formation and EGM changes using the bidomain model. Simulations were performed on a three-dimensional setup including a geometrically detailed representation of the catheter with highly conductive electrodes. For validation, EGMs recorded during RFA procedures in five patients were analyzed and compared to simulation results. Clinical data showed major changes in the distal unipolar EGM. During RFA, the negative peak amplitude decreased up to 104% and maximum negative deflection was up to 88% smaller at the end of the ablation sequence. These changes mainly occurred in the first 10 s after ablation onset. Simulated unipolar EGMs reproduced the clinical changes, reaching up to 83% negative peak amplitude reduction and 80% decrease in maximum negative deflection for transmural lesions. In future studies, the established model may enable the development of further EGM criteria for transmural lesions even for complex geometries in order to support clinical therapy.

Optical mapping in the developing zebrafish heart

Understanding the developmental basis of cardiac electrical activity has proven technically challenging, largely as a result of the inaccessible nature of the heart during cardiogenesis in many organisms. The emergence of the zebrafish as a model organism has availed the very earliest stages of heart formation to experimental exploration. The zebrafish also offers a robust platform for genetic and chemical screening. These tools have been exploited in screens for modifiers of cardiac electrophysiologic phenotypes and in screens for novel drugs.

The role of coronary sinus musculature in the induction of atrial fibrillation

BACKGROUND

Coronary sinus (CS) musculature connects the right atria (RA) and the left atria (LA). However, the functional significance of the electrical junctions between the atria and the CS musculature is still unclear.

OBJECTIVE

We investigated electrophysiological properties of the CS-atrial connections and their role in atrial fibrillation.

METHODS

By using an optical mapping system, we mapped action potentials at 256 sites on the epicardial surface of 16 isolated and arterial-perfused canine atrial tissues containing the entire musculature of the CS, lower RA, posterior LA, left inferior pulmonary vein, and vein of Marshal. We paced from each of the above regions to measure electrophysiological properties and inducibility of atrial tachyarrhythmias.

RESULTS

The CS musculature connected to the RA at the ostium of the CS and to the LA at proximal and distal CS sites. Electrical conduction across each of these CS-atrial junctions was slow (P < .01), but not decremental. Rapid pacing often induced entrance block at the CS-atrial junctions and resulted in sequential changes of activation sequence in the CS. Macroreentrant circuit involving the CS musculature and the CS-atrial junctions occurred in association with conduction block at these junctions. The reentrant circuit was usually unstable and resulted in atrial fibrillation-like electrocardiographic activity.

CONCLUSIONS

The anatomical and electrical connections between the CS musculature and the RA and the LA caused conduction slowing and block in the CS musculature and its atrial junctions, which frequently initiated unstable macroreentry and atrial fibrillation.

Functional and morphological preservation of adult ventricular myocytes in culture by sub-micromolar cytochalasin D supplement

In cardiac myocytes, cytochalasin D (CytoD) was reported to act as an actin disruptor and mechanical uncoupler. Using confocal and super-resolution STED microscopy, we show that CytoD preserves the actin filament architecture of adult rat ventricular myocytes in culture. Five hundred nanomolar CytoD was the optimal concentration to achieve both preservation of the T-tubular structure during culture periods of 3 days and conservation of major functional characteristics such as action potentials, calcium transients and, importantly, the contractile properties of single myocytes. Therefore, we conclude that the addition of CytoD to the culture of adult cardiac myocytes can indeed be used to generate a solid single-cell model that preserves both morphology and function of freshly isolated cells. Moreover, we reveal a putative link between cytoskeletal and T-tubular remodeling. In the absence of CytoD, we observed a loss of T-tubules that led to significant dyssynchronous Ca(2+)-induced Ca(2+) release (CICR), while in the presence of 0.5 μM CytoD, T-tubules and homogeneous CICR were majorly preserved. Such data suggested a possible link between the actin cytoskeleton, T-tubules and synchronous, reliable excitation-contraction-coupling. Thus, T-tubular re-organization in cell culture sheds some additional light onto similar processes found during many cardiac diseases and might link cytoskeletal alterations to changes in subcellular Ca(2+) signaling revealed under such pathophysiological conditions.

Short-term memory and electrical restitution in the canine transmural ventricle

Cardiac short-term memory is an intrinsic property of paced myocardium that reflects the influence of pacing history. Using an optical mapping method to record membrane voltage and intracellular calcium (Ca(2 +)(i)), this study investigated the properties and mechanisms of short-term memory in isolated and perfused canine wedge preparations. In addition to the dynamic and S1S2 pacing protocols, a perturbed downsweep pacing protocol was used to get a complete overview of the restitution portrait. Abrupt changes in basic cycle length (BCL) were applied to investigate the accommodation process of action potential duration (APD). The results showed unobvious differences of memory among the epi-, mid- and endo-myocytes, implying an insignificant memory-induced transient heterogeneity in APD across the transmural canine hearts. With the decrease of pacing rate S1, memory gradually elevated and achieved a maximum around 400 ms, and then reduced as S1 decreased further, indicating a non-monotonic relationship between memory and the pacing rate. After suppressing the Ca(2 +)(i) transient with ryanodine (3 µmol l(-1)), the accommodation process of APD to a new BCL significantly abbreviated (τ = 37.41 ± 4.42 stimuli before ryanodine, τ = 15.84 ± 4.74 stimuli after ryanodine, p < 0.01). Therefore, Ca(2 +)(i) cycling was suggested to play an important role in memory during dynamic pacing.

Assessment of cardiac conduction: basic principles of optical mapping

Extracellular recordings acquired from electrodes placed on the surface of cardiac tissue have traditionally been used to study the electrophysiological properties of the tissue. While this technique has been used in several studies that have increased our understanding of cardiac arrhythmias and action potential propagation, there are several limitations that have prevented us from seeing a bigger picture of arrhythmia mechanisms. These limitations include the limited number of electrodes and unstable recordings. Optical mapping was developed to increase the temporal and spatial resolution over traditional electrode recordings and ultimately the accuracy of the data analysis. This technology involves using a voltage-sensitive dye that binds to the cell membrane. The fluorescence changes of the dye have a linear relationship to the action potential changes of the cell membrane. These fluorescent changes can then be detected by a photodiode array, a CCD camera or a CMOS camera. This will allow the recording of the action potential in hundreds to thousands of different sites simultaneously. Presented in this chapter are the materials and hardware needed along with step-by-step instructions on setup and techniques used in optical mapping for larger tissue preparations.

In vitro electrophysiological mapping of stem cells

The use of stem cells for cardiac regeneration is a revolutionary, emerging research area. For proper function as replacement tissue, stem cell-derived cardiomyocytes (SC-CMs) must electrically couple with the host cardiac tissue. Electrophysiological mapping techniques, including microelectrode array (MEA) and optical mapping, have been developed to study cardiomyocytes and cardiac cell monolayers, and these can be applied to study stem cells and SC-CMs. MEA recordings take extracellular measurements at numerous points across a small area of cell cultures and are used to assess electrical propagation during cell culture. Optical mapping uses fluorescent dyes to monitor electrophysiological changes in cells, most commonly transmembrane potential and intracellular calcium, and can be easily scaled to areas of different sizes. The materials and methods for MEA and optical mapping are presented here, together with detailed notes on their use, design, and fabrication. We also provide examples of voltage and calcium maps of mouse embryonic stem cell-derived cardiomyocytes (mESC-CMs), obtained in our laboratory using optical mapping techniques.

Simultaneous optical mapping of intracellular free calcium and action potentials from Langendorff perfused hearts

The cardiac action potential (AP) controls the rise and fall of intracellular free Ca2+ (Ca(i)), and thus the amplitude and kinetics of force generation. Besides excitation-contraction coupling, the reverse process where Ca(i) influences the AP through Ca(i)-dependent ionic currents has been implicated as the mechanism underlying QT alternans and cardiac arrhythmias in heart failure, ischemia/reperfusion, cardiac myopathy, myocardial infarction, congenital and drug-induced long QT syndrome, and ventricular fibrillation. The development of dual optical mapping at high spatial and temporal resolution provides a powerful tool to investigate the role of Ca(i) anomalies in eliciting cardiac arrhythmias. This unit describes experimental protocols to map APs and Ca(i) transients from perfused hearts by labeling the heart with two fluorescent dyes, one to measure transmembrane potential (Vm), the other Ca(i) transients. High spatial and temporal resolution is achieved by selecting Vm and Ca(i) probes with the same excitation but different emission wavelengths, to avoid cross-talk and mechanical components.

Basic concepts of optical mapping techniques in cardiac electrophysiology

Optical mapping is a tool used in cardiac electrophysiology to study the heart's normal rhythm and arrhythmias. The optical mapping technique provides a unique opportunity to obtain membrane potential recordings with a higher temporal and spatial resolution than electrical mapping. Additionally, it allows simultaneous recording of membrane potential and calcium transients in the whole heart. This article presents the basic concepts of optical mapping techniques as an introduction for students and investigators in experimental laboratories unfamiliar with it.

Membrane time constant during internal defibrillation strength shocks in intact heart: effects of Na+ and Ca2+ channel blockers

INTRODUCTION

We assessed defibrillation strength shock-induced changes of the membrane time constant (tau) and membrane potential (DeltaVm) in intact rabbit hearts after administration of lidocaine, a sodium (Na(+)) channel blocker, or nifedipine, a L-type calcium (Ca(2+)) channel blocker.

METHODS AND RESULTS

We optically mapped anterior, epicardial, electrical activity during monophasic shocks (+/-100, +/-130, +/-160, +/-190, and +/-220 V; 150 microF; 8 ms) applied at 25%, 50%, and 75% of the action potential duration via a shock lead system in Langendorff-perfused hearts. The protocol was run twice for each heart under control and after lidocaine (15 microM, n = 6) or nifedipine (2 microM, n = 6) addition. tau in the virtual electrode area away from the shock lead was approximated with single-exponential fits from a total of 121,125 recordings. The same data set was used to calculate DeltaVm. We found (1) Under all conditions, there is inverse relationship between tau and DeltaVm with respect to changes of shock strength, regardless of shock polarity and phase of application: a stronger shock resulted in a larger DeltaVm, which corresponded to a smaller tau (faster cellular response); (2) Lidocaine did not cause appreciable changes in either tau or DeltaVm versus control, and (3) Nifedipine significantly increased both tau and DeltaVm in the virtual cathode area; in contrast, in the virtual anode area, this effect depended on the phase of shock application.

CONCLUSION

tau and DeltaVm are inversely related. Na(+) channel blocker has minimal impact on either tau or DeltaVm. Ca(2+) blocker caused polarity and phase-dependent significant changes in tau and DeltaVm.

Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome

BACKGROUND

Conduction abnormalities serve as a substrate for ventricular fibrillation (VF) in patients with Brugada syndrome (BS). Signal-averaged electrograms can detect late potentials, but the significance of conduction abnormalities within the QRS complex is still unknown. The latter can present as multiple spikes within the QRS complex (fragmented QRS [f-QRS]). We hypothesized that f-QRS could indicate a substrate for VF and might predict a high risk of VF for patients with BS.

METHODS AND RESULTS

In study 1, we analyzed the incidence of f-QRS in 115 patients with BS (13 resuscitated from VF, 28 with syncope, and 74 asymptomatic). f-QRS was observed in 43% of patients, more often in the VF group (incidence of f-QRS: VF 85%, syncope 50%, and asymptomatic 34%, P<0.01). SCN5A mutations occurred more often in patients with f-QRS (33%) than in patients without f-QRS (5%). In patients with syncope or VF, only 6% without f-QRS experienced VF during follow-up (43+/-25 months), but 58% of patients with f-QRS had recurrent syncope due to VF (P<0.01). In study 2, to investigate the mechanism of f-QRS, we studied in vitro models of BS in canine right ventricular tissues (n=4) and optically mapped multisite action potentials. In the experimental model of BS, ST elevation resulted from a large phase 1 notch of the action potential in the epicardium, and local epicardial activation delay reproduced f-QRS in the transmural ECG.

CONCLUSIONS

f-QRS appears to be a marker for the substrate for spontaneous VF in BS and predicts patients at high risk of syncope.

Acute ischemia of canine interventricular septum produces asymmetric suppression of conduction

BACKGROUND

Acute ischemia depresses tissue excitability more rapidly in the epicardium than in the endocardium of the canine left ventricular (LV) free wall. However, the effects of acute ischemia on conduction in the interventricular septum (IVS), which is composed of right ventricular (RV) and LV endocardium and midmyocardium without epicardium, are less known.

OBJECTIVE

The purpose of this study was to evaluate the hypothesis that the IVS exhibits transseptal differences in local tissue response to acute ischemia.

METHODS

Isolated canine IVS preparations were perfused through the septal branch of the anterior descending coronary artery, and conduction on the cut-exposed transseptal surfaces was optically mapped before and after two sequential episodes of 8 minutes of global ischemia (separated by >60 minutes of reperfusion). The preparations were paced alternately between the RV endocardium and LV endocardium at cycle lengths of 250, 300, and 1,500 ms.

RESULTS

Prior to ischemia, transseptal conduction was radial and symmetric during either RV endocardial or LV endocardial pacing at all cycle lengths. Eight minutes of ischemia depressed conduction velocity more in the RV half than in the LV half of the IVS and caused local conduction block in the sub-RV endocardium, especially during rapid pacing. The K(ATP) channel blocker glibenclamide (10 micromol/L) prevented development of this transseptal asymmetry and conduction block during ischemia.

CONCLUSION

Acute global ischemia increased transseptal heterogeneity and induced sub-RV endocardial block of conduction via activation of the ATP-sensitive potassium current. Such changes could contribute to initiation of arrhythmia in patients with septal infarction.

Elasticity, unexpected contractility and the identification of actin and myosin in lobster arteries

Lobster arteries, which exhibit non-uniform elasticity when stretched, have a trilaminar organization. The inner layer is an elastic connective tissue and the outer layer is a collagenous connective tissue; the middle layer of an artery is an aggregation of cells containing microfilaments. Arterial cells possess actin, myosin and tropomyosin. Except for the dorsal abdominal artery,striated muscle cells are not evident in the walls of any of the vessels. The neurotransmitter glutamic acid and the neurohormone proctolin elicit slow circumferential contractions in all of the arteries leaving the lobster heart. Only the dorsal abdominal artery contracts when stimulated electrically. Longitudinal strips of the arteries do not respond to either drugs or electrical stimulation. Arterial contraction will have profound effects on resistance to blood flow and may be an important component of the control mechanisms regulating blood distribution.

The role of mechanoelectric feedback in vulnerability to electric shock

Experimental and clinical studies have shown that ventricular dilatation is associated with increased arrhythmogenesis and elevated defibrillation threshold; however, the underlying mechanisms remain poorly understood. The goal of the present study was to test the hypothesis that (1) stretch-activated channel (SAC) recruitment and (2) geometrical deformations in organ shape and fiber architecture lead to increased arrhythmogenesis by electric shocks following acute ventricular dilatation. To elucidate the contribution of these two factors, the study employed, for the first time, a combined electro-mechanical simulation approach. Acute dilatation was simulated in a model of rabbit ventricular mechanics by raising the LV end-diastolic pressure from 0.6 (control) to 4.2 kPa (dilated). The output of the mechanics model was used in the electrophysiological model. Vulnerability to shocks was examined in the control, the dilated ventricles, and in the dilated ventricles that also incorporated currents through SAC as a function of local strain, by constructing vulnerability grids. Results showed that dilatation-induced deformation alone decreased upper limit of vulnerability (ULV) slightly and did not result in increased vulnerability. With SAC recruitment in the dilated ventricles, the number of shock-induced arrhythmia episodes increased by 37% (from 41 to 56) and the lower limit of vulnerability (LLV) decreased from 9 to 7 V/cm, while ULV did not change. The heterogeneous activation of SAC caused by the heterogeneous fiber strain in the ventricular walls was the main reason for increased vulnerability to electric shocks since it caused dispersion of electrophysiological properties in the tissue, resulting in postshock unidirectional block and establishment of reentry.

Optical mapping system with real-time control capability

Real-time, closed-loop intervention is an emerging experiment-control method that promises to provide invaluable new insight into cardiac electrophysiology. One example is the investigation of closed-loop feedback control of cardiac activity (e.g., alternans) as a possible method of preventing arrhythmia onset. To date, such methods have been investigated only in vitro using microelectrode systems, which are hindered by poor spatial resolution and are not well suited for atrial or ventricular tissue preparations. We have developed a system that uses optical mapping techniques and an electrical stimulator as the sensory and effector arms, respectively, of a closed-loop, real-time control system. The system consists of a 2,048 x 1 pixel line-scan charge-coupled device camera that records optical signals from the tissue. Custom-image processing and control software, which is implemented on top of a hard real-time operation system (RTAI Linux), process the data and make control decisions with a deterministic delay of <1 ms. The system is tested in two ways: 1) it is used to control, in real time, simulated optical signals of electrical alternans; and 2) it uses precisely timed, feedback-controlled initiation of antitachycardia pacing to terminate reentrant arrhythmias in an arterially perfused swine right ventricle stained with voltage-sensitive fluorescent dye 4{beta-[2-(di-n-butylamino)-6-napathy]vinyl}pyridinium (di-4-ANEPPS). Thus real-time control of cardiac activity using optical mapping techniques is feasible. Such a system is attractive because it offers greater measurement resolution than the electrode-based systems with which real-time control has been used previously.

A fiber-based ratiometric optical cardiac mapping channel using a diffraction grating and split detector

Optical fiber-based mapping systems are used to record the cardiac action potential (AP) throughout the myocardium. The optical AP contains a contraction-induced motion artifact (MA), which makes it difficult to accurately measure the action potential duration (APD). MA is removed by preventing contraction with electrical-mechanical uncoupling drugs, such as 2,3-butanedione monoxime (BDM). We designed a novel fiber-based ratiometric optical channel using a blue light emitting diode, a diffraction grating, and a split photodetector that can accurately measure the cardiac AP without the need for BDM. The channel was designed based on simulations using the optical design software ZEMAX. The channel has an electrical bandwidth of 150 Hz and an root mean-square dark noise of 742 muV. The channel successfully recorded the cardiac AP from the wall of five rabbit heart preparations without the use of BDM. After 20-point median filtering, the mean signal/noise ratio was 25.3 V/V. The APD measured from the base of a rabbit heart was 134 +/- 8.4 ms, compared to 137.6 +/- 3.3 ms from simultaneous microelectrode recordings. This difference was not statistically significant (p-value = 0.3). The quantity of MA removed was also measured using the motion ratio. The reduction in MA was significant (p-value = 0.0001). This fiber-based system is the first of its kind to enable optical APD measurements in the beating heart wall without the use of BDM.

Differences in arrhythmogenicity between the canine right ventricular outflow tract and anteroinferior right ventricle in a model of Brugada syndrome

BACKGROUND

The Brugada syndrome is characterized by ST-segment elevation on the ECG, especially in the right precordial leads sensitive to the right ventricular outflow tract (RVOT).

OBJECTIVES

The purpose of this study was to evaluate the hypothesis that right ventricular electrophysiologic heterogeneity caused arrhythmogenicity in the Brugada syndrome.

METHODS

Action potentials (APs) were mapped on the epicardium of 14 RVOT preparations and on the transmural surfaces of 15 pairs of RVOT and right ventricular anteroinferior (RVAI) preparations isolated from canine hearts. Brugada ECG and arrhythmias were induced with pilsicainide (2.5-12.5 micromol/L), pinacidil (1.25-12.5 micromol/L), and terfenadine (2.0 micromol/L).

RESULTS

Low doses of drugs elevated the J-ST segment and induced APs with both short and long action potential durations (APDs) in contiguous RVOT epicardial regions. In addition, APs in the RVOT had a larger phase 1 notch and longer APD than in RVAI. The longest APDs were in the epicardium in RVOT but in the endocardium in RVAI regions. High doses of drugs eliminated the phase 2 dome of the AP and abbreviated APDs in the epicardium but not in endocardium and reduced the epicardial heterogeneity of APs but increased the transmural gradient of APD in 14 (93%) of the RVOT preparations. In contrast, abbreviations of epicardial APDs occurred in only 4 (27%) of the RVAI preparations. Ventricular tachycardia occurred more frequently in the RVOT (47%) than in paired RVAI preparations (7%). Blocking the transient outward current reduced the heterogeneity of APs and eliminated arrhythmogenicity in all preparations.

CONCLUSION

Compared with the RVAI region, the RVOT has greater electrophysiologic heterogeneity that contributes to arrhythmogenicity in this model of Brugada syndrome.

Dynamic changes of cardiac conduction during rapid pacing

Slow conduction and unidirectional conduction block (UCB) are key mechanisms of reentry. Following abrupt changes in heart rate, dynamic changes of conduction velocity (CV) and structurally determined UCB may critically influence arrhythmogenesis. Using patterned cultures of neonatal rat ventricular myocytes grown on microelectrode arrays, we investigated the dynamics of CV in linear strands and the behavior of UCB in tissue expansions following an abrupt decrease in pacing cycle length (CL). Ionic mechanisms underlying rate-dependent conduction changes were investigated using the Pandit-Clark-Giles-Demir model. In linear strands, CV gradually decreased upon a reduction of CL from 500 ms to 230-300 ms. In contrast, at very short CLs (110-220 ms), CV first decreased before increasing again. The simulations suggested that the initial conduction slowing resulted from gradually increasing action potential duration (APD), decreasing diastolic intervals, and increasing postrepolarization refractoriness, which impaired Na(+) current (I(Na)) recovery. Only at very short CLs did APD subsequently shorten again due to increasing Na(+)/K(+) pump current secondary to intracellular Na(+) accumulation, which caused recovery of CV. Across tissue expansions, the degree of UCB gradually increased at CLs of 250-390 ms, whereas at CLs of 180-240 ms, it first increased and subsequently decreased. In the simulations, reduction of inward currents caused by increasing intracellular Na(+) and Ca(2+) concentrations contributed to UCB progression, which was reversed by increasing Na(+)/K(+) pump activity. In conclusion, CV and UCB follow intricate dynamics upon an abrupt decrease in CL that are determined by the interplay among I(Na) recovery, postrepolarization refractoriness, APD changes, ion accumulation, and Na(+)/K(+) pump function.

Temperature modulation of ventricular arrhythmogenicity in a canine tissue model of Brugada syndrome

BACKGROUND

Fever promotes ventricular arrhythmias in Brugada syndrome (BrS). Hypothermia can induce BrS electrocardiogram (ECG) and arrhythmia. However, the mechanisms are unclear.

OBJECTIVE

We evaluated the hypothesis that pathological temperatures promoted arrhythmogenesis by modulating the spatial heterogeneity and functional dynamics of right ventricular electrophysiological activity.

METHODS

We mapped action potentials (APs) on the epicardial or cut-exposed transmural surfaces and recorded transmural ECGs in 27 arterially perfused canine right ventricular preparations before and after inducing BrS at 32 degrees C, 36.5 degrees C, and 40 degrees C.

RESULTS

We observed major intraepicardial dispersion of AP duration (APD) and reversal of transmural gradient of APD in association with manifestation of BrS at 36.5 degrees C. Reducing the temperature to 32 degrees C prolonged APDs and enhanced the phase 1 notch of epicardial APs, while 40 degrees C caused opposite changes. Prominent phase 2 domes of APs frequently led to spontaneous premature ventricular activations (PVAs), which conducted to surrounding regions having shorter APDs. Longer APDs at 32 degrees C and 36.5 degrees C frequently blocked reentry, although they promoted PVA, while shortened APDs at 40 degrees C facilitated reentrant ventricular tachycardia. During bradycardia (2,000 ms), the J-ST elevation in the ECG was enhanced at 32 degrees C and attenuated at 40 degrees C. Rapid pacing (500 ms) eliminated the dome of epicardial APs and enhanced J-ST elevation at each temperature. Blocking the transient outward current, I(to), with 4-aminopyridine reduced J-ST elevation and eliminated the PVA and reentry.

CONCLUSIONS

In this BrS model, prolongation and increased dispersion of APDs promoted spontaneous activation during hypothermia, while APD abbreviation facilitated reentry during hyperthermia. I(to) mediated the arrhythmogenicity.

Cytochalasin D as the depressant of contraction for the optical monitoring of action potentials in isolated rat atrium

We used cytochalasin D to reduce contraction-related optical signals by inhibiting muscle contraction for the optical monitoring of action potentials, using a voltage-sensitive dye in isolated rat atrium preparations. The suppression of contraction-related signals was so strong that we concluded that this chemical is suitable for this purpose.

Pacing-induced heterogeneities in intracellular Ca2+ signaling, cardiac alternans, and ventricular arrhythmias in intact rat heart

Optical mapping studies have suggested that intracellular Ca2+ and T-wave alternans are linked through underlying alternations in Ca2+ cycling-inducing oscillations in action potential duration through Ca2+-sensitive conductances. However, these studies cannot measure single-cell behavior; therefore, the Ca2+ cycling heterogeneities within microscopic ventricular regions are unknown. The goal of this study was to measure cellular activity in intact myocardium during rapid pacing and arrhythmias. We used single-photon laser-scanning confocal microscopy to measure Ca2+ signaling in individual myocytes of intact rat myocardium during rapid pacing and during pacing-induced ventricular arrhythmias. At low rates, all myocytes demonstrate Ca2+ alternans that is synchronized but whose magnitude varies depending on recovery kinetics of Ca2+ cycling for each individual myocyte. As rate increases, some cells reverse alternans phase, giving a dyssynchronous activation pattern, even in adjoining myocytes. Increased pacing rate also induces subcellular alternans where Ca2+ alternates out of phase with different regions within the same cell. These forms of heterogeneous Ca2+ signaling also occurred during pacing-induced ventricular tachycardia. Our results demonstrate highly nonuniform Ca2+ signaling among and within individual myocytes in intact heart during rapid pacing and arrhythmias. Thus, certain pathophysiological conditions that alter Ca2+ cycling kinetics, such as heart failure, might promote ventricular arrhythmias by exaggerating these cellular heterogeneities in Ca2+ signaling.

Matrix metalloproteinase-7 affects connexin-43 levels, electrical conduction, and survival after myocardial infarction

BACKGROUND

Matrix metalloproteinases (MMPs) contribute to left ventricular remodeling after myocardial infarction (MI). Specific causative roles of particular MMPs, however, remain unclear. MMP-7 is abundant in cardiomyocytes and macrophages, but MMP-7 function after MI has not been defined.

METHODS AND RESULTS

Wild-type (WT; n=55) and MMP-7-null (MMP-7-/-; n=32) mice underwent permanent coronary artery ligation for 7 days. MI sizes were similar, but survival was greatly improved in MMP-7-/- mice. The survival difference could not be attributed to differences in left ventricular dilation because end-diastolic volumes increased similarly. ECG analysis revealed a prolonged PR interval in WT but not in MMP-7-/- post-MI mice. Post-MI conduction velocity, determined by optically mapping electrical wavefront propagation, decreased to 78+/-6% of control for WT and was normalized in MMP-7-/- mice. In WT mice, slower conduction velocity correlated with a 53% reduction in the gap junction protein connexin-43. Direct binding of MMP-7 to connexin-43, determined by surface plasmon resonance technology, occurred in a dose-dependent manner. Connexin-43 processing by MMP-7 was confirmed by in silico and in vitro substrate analyses and MMP-7 infusion induced arrhythmias in vivo.

CONCLUSIONS

MMP-7 deletion results in improved survival and myocardial conduction patterns after MI. This is the first report to implicate MMP-7 in post-MI remodeling and to demonstrate that connexin-43 is a novel MMP-7 substrate.

Measurements of Electrophysiological Effects of Components of Acute Ischemia in Langendorff-Perfused Rat Hearts Using Voltage-Sensitive Dye Mapping

INTRODUCTION

This study was carried out to evaluate optical mapping in the presence of cytochalasin-D as a method for measuring electrophysiological responses in general, and in particular the responses to acute ischemia in the Langendorff-perfused rat heart. Cytochalasin-D is commonly used to reduce contraction for the purpose of suppressing motion artifacts in voltage-sensitive dye recordings of cardiac membrane potential.

METHODS AND RESULTS

Observations using optical mapping were complemented by recordings of the surface electrogram to provide information independent of the optical measurements. Perfusion of Langendorff-perfused rat hearts with 3 microM cytochalasin-D resulted in a 24% prolongation of the QT interval of surface electrograms indicating that cytochalasin-D prolongs the rat ventricular action potential. Individual components of the electrophysiological response to acute ischemia were globally induced as follows: (1) opening of K(ATP) channels was induced by perfusion of 2 micro M P-1,075, (2) accumulation of extracellular K(+) was simulated by increasing perfusate [K(+)] to 12 mM, and (3) acidosis was simulated by reducing perfusate pH to 6.5. The responses to these interventions could be reliably documented using optical recordings, as well as from surface electrograms. Whole-cell patch clamp measurements on isolated rat ventricular myocytes indicate that cytochalasin-D produces an approximately 2.5-fold increase in P-1,075-induced I(K,ATP).

CONCLUSION

These results provide the necessary background information for interpreting electrophysiological measurements during acute ischemia in the presence of cytochalasin-D.

T wave alternans in an in vitro canine tissue model of Brugada syndrome

Macroscopic T wave alternans (TWA) associated with increased occurrence of ventricular arrhythmias has been reported in patients with Brugada syndrome. However, the mechanisms in this syndrome are still unclear. We evaluated the hypothesis that TWA in Brugada syndrome was caused by the dynamic instability and heterogeneity of action potentials (APs) in the right ventricle. Using an optical mapping system, we mapped APs on the epicardium or transmural surfaces of 28 isolated and arterially perfused canine right ventricular preparations having drug-induced Brugada syndrome (in micromol/l: 2.5-15 pinacidil, 5.0 terfenadine, and 5.0-13 pilsicainide). Bradycardia at cycle length (CL) of 2,632 +/- 496 ms (n = 19) induced alternating deep and shallow T waves in the transmural electrocardiogram. Compared with the shallow T waves, deep T waves were associated with epicardial APs having longer durations and larger domes. Adjacent regions having APs with alternating domes, with constant domes, and without domes coexisted simultaneously in the epicardium and caused TWA. In contrast to the alternating epicardial APs, midmyocardial and endocardial APs did not change during TWA. Alternans could be terminated by rapid (CL: 529 +/- 168 ms, n = 7) or very slow (CL: 3,000 ms, n = 7) pacing. The heterogeneic APs during TWA augmented the dispersion of repolarization both within the epicardium and from the epicardium to the endocardium and caused phase 2 reentry. In this drug-induced model of Brugada syndrome, heterogeneic AP contours and dynamic alternans in the dome of right ventricular epicardial, but not midmyocardial or endocardial, APs caused TWA and heightened arrhythmogenicity in part by increasing the dispersion of repolarization.

In situ Ca2+ dynamics of Purkinje fibers and its interconnection with subjacent ventricular myocytes

Purkinje fibers play essential roles in impulse propagation to the ventricles, and their functional impairment can become arrhythmogenic. However, little is known about precise spatiotemporal pattern(s) of interconnection between Purkinje-fiber network and the underlying ventricular myocardium within the heart. To address this issue, we simultaneously visualized intracellular Ca(2+) dynamics at Purkinje fibers and subjacent ventricular myocytes in Langendorff-perfused rat hearts using multi-pinhole type, rapid-scanning confocal microscopy. Under recording of electrocardiogram at room temperature spatiotemporal changes in fluo3-fluorescence intensity were visualized on the subendocardial region of the right-ventricular septum. Staining of the heart with either fluo3, acetylthiocholine iodide (ATCHI), or di-4-ANEPPS revealed characteristic structures of Purkinje fibers. During sinus rhythm (about 60 bpm) or atrial pacing (up to 3 Hz) each Purkinje-fiber exhibited spatiotemporally synchronous Ca(2+) transients nearly simultaneously to ventricular excitation. Ca(2+) transients in individual fibers were still synchronized within the Purkinje-fiber network not only under high-K(+) (8 mM) perfusion-induced Purkinje-to-ventricular (P-V) conduction delay, but also under unidirectional, orthodromic P-V block produced by 10-mM K(+) perfusion. While spontaneous, asynchronous intracellular Ca(2+) waves were identified in injured fibers of Purkinje network locally, surrounding fibers still exhibited Ca(2+) transients synchronously to ventricular excitation. In summary, these results are the first demonstration of intracellular Ca(2+) dynamics in the Purkinje-fiber network in situ. The synchronous Ca(2+) transients, preserved even under P-V conduction disturbances or under emergence of Ca(2+) waves, imply a syncytial role of Purkinje fibers as a specialized conduction system, whereas unidirectional block at P-V junctions indicates a substrate for reentrant arrhythmias.

Coronary occlusion and reperfusion promote early afterdepolarizations and ventricular tachycardia in a canine tissue model of type 3 long QT syndrome

Although long QT syndrome (LQTS) and coronary occlusion-reperfusion (O/R) are arrhythmogenic, they affect ventricular action potential duration (APD) differently. In contrast to the prolonged APD in LQTS, ischemia abbreviates APD after a transient prolongation. Thus we hypothesized that the dynamic interactive effects of ischemia and LQTS on APD and its dispersion would affect ventricular arrhythmogenicity. We mapped transmural distribution of action potentials in 6 groups of 10 isolated wedges of canine ventricular walls: LQTS-O/R, LQTS only, and O/R only, with separate groups for pacing cycle lengths (PCL) of 1,000 and 2,000 ms. We created type 3 LQTS with anemone toxin (ATX) II followed >30 min later by arterial occlusion (40 min) and reperfusion (>100 min). Arterial occlusion initially (first 4 min) prolonged and then shortened APD. Early afterdepolarizations (EADs) occurred during the initial 4 min of occlusion in 4 of the 10 LQTS-O/R wedges at PCL of 2,000 ms but not in the other groups. Reperfusion restored APD in the O/R-only groups but caused APD to overshoot its original duration, indicating depressed repolarization reserve, in the LQTS-O/R group. Reperfusion increased the dispersion of APDs and initiated ventricular tachycardia-fibrillation in 7 of 10 and 6 of 10 LQTS-O/R wedges and in 2 of 10 and 1 of 10 O/R-only wedges at PCLs of 1,000 and 2,000 ms, respectively. The LQTS-only wedges exhibited neither EADs nor ventricular tachycardia. We conclude that coronary O/R increased the arrhythmogenicity of LQTS via cumulative prolongation of APD, increase in repolarization dispersion, and suppression of repolarization reserve.

Head-tail interactions in numerical simulations of reentry in a ring of cardiac tissue

BACKGROUND

The relationships between action potential duration (APD) and conduction velocity (CV) to the previous diastolic interval (DI) are known as the APD and CV restitution relationships. There is considerable debate regarding the importance of these relationships in the development and stability of reentry.

OBJECTIVES

The purpose of this study was to increase the understanding of the ionic basis for restitution during reentry.

METHODS

APD and CV were studied numerically during one-dimensional reentry as ring length (L) was shortened. A three-state variable model (u, v, w) was used to analyze the effect of gating variables of the fast (v) and slow (w) currents on the spatial and temporal dynamics of transmembrane potential (u). Three parameter sets were used corresponding to three APD and CV restitution curves.

RESULTS

Sustained spatial oscillations of APD and CV larger than the ring length were observed in two of the parameter sets (cytochalasin-D model [CYTO] and model 3 [M3]) before block occurred at L = 6 cm. The last model (diacetyl monoxime [DAM]) resulted in uniform APD and CV for all L until block occurred at L = 3 cm. Multivalued APD and CV restitution relationships due to "dephasing" of w and v with DI were observed in M3 and CYTO simulations. Overall, these dynamics could be explained by the wavelength-to-ring length ratio and the sensitivity of APD on the value of the gating variables w and v.

CONCLUSION

Propagation stability is mostly controlled by APD sensitivity to w, but the APD restitution slope does not always reflect this sensitivity. The interaction of the dynamic history (i.e., memory) of the fast and slow currents and electrotonic effects resulted in multivalued restitution curves.

Head-tail interactions in numerical simulations of reentry in a ring of cardiac tissue

BACKGROUND

The relationships between action potential duration (APD) and conduction velocity (CV) to the previous diastolic interval (DI) are known as the APD and CV restitution relationships. There is considerable debate regarding the importance of these relationships in the development and stability of reentry.

OBJECTIVES

The purpose of this study was to increase the understanding of the ionic basis for restitution during reentry.

METHODS

APD and CV were studied numerically during one-dimensional reentry as ring length (L) was shortened. A three-state variable model (u, v, w) was used to analyze the effect of gating variables of the fast (v) and slow (w) currents on the spatial and temporal dynamics of transmembrane potential (u). Three parameter sets were used corresponding to three APD and CV restitution curves.

RESULTS

Sustained spatial oscillations of APD and CV larger than the ring length were observed in two of the parameter sets (cytochalasin-D model [CYTO] and model 3 [M3]) before block occurred at L = 6 cm. The last model (diacetyl monoxime [DAM]) resulted in uniform APD and CV for all L until block occurred at L = 3 cm. Multivalued APD and CV restitution relationships due to "dephasing" of w and v with DI were observed in M3 and CYTO simulations. Overall, these dynamics could be explained by the wavelength-to-ring length ratio and the sensitivity of APD on the value of the gating variables w and v.

CONCLUSION

Propagation stability is mostly controlled by APD sensitivity to w, but the APD restitution slope does not always reflect this sensitivity. The interaction of the dynamic history (i.e., memory) of the fast and slow currents and electrotonic effects resulted in multivalued restitution curves.

Advances in electrical and mechanical cardiac mapping

Cardiac mapping--recording cardiac activity during electrophysiological testing--has evolved into an indispensable tool in studying the cardiac excitation process, analysing activation patterns, and identifying arrhythmogenic tissue. Cardiac mapping is a broad term that is used here to encompass applications that record electrical or mechanical activity of the heart or both. In recent years, simultaneous and sequential electrical mapping methods have been combined with direct mechanical measurements or imaging techniques to acquire information regarding both the electrical and mechanical activity of the heart (electromechanical mapping) during normal and irregular cardiac behavior. This paper reviews the emerging area of electromechanical mapping from the point of view of the applicable technology, including its history and application.

Characteristics of a charged-coupled-device-based optical mapping system for the study of cardiac arrhythmias

We develop an optical fluorescent mapping system that is able to record the action potential wavefront propagation within cardiac tissue samples with high spatial and temporal resolutions. The system's main component, the fluorescence acquisition device (customized CCD camera), offers a high spatial resolution of 128 x 128 pixels, with 12-bit digitization and a frame rate of 490 frames/s. The system is designed and implemented to image an area of approximately 20 x 20 mm at its minimum object distance of 140 mm, corresponding to a spatial resolution of approximately 3 line pairs/mm. Experiments using this system with di-4-ANEPPS-stained canine cardiac tissues with stimulated action potentials through external electrodes result in successful mappings of the distribution and propagation of the action potential wavefronts, showing the system's sensitivity to the change in fluorescence intensity in regions of action potentials. These data demonstrate this optical mapping system as a powerful device in the study of cardiac arrhythmia mechanisms.

Functional and transmural modulation of M cell behavior in canine ventricular wall

Previous studies have demonstrated a discrete population of midmyocardial (M) cells in the ventricular myocardium having excessive action potential duration (APD) prolongation during long activation cycle lengths (CL) and under the influence of APD-prolonging agents. However, M cells have not been found in other studies. Existing explanations for the discrepancies appear inadequate. We hypothesized that instead of being a discrete group, M cell behavior is functional and conditionally expressed. We mapped APDs on the cut-exposed transmural surfaces of arterially perfused ventricular wedges from 26 dogs during Na+ current modification with anemone toxin II (ATX-II). Compared with the endocardium, APDs were not statistically different in the parallel layer having the longest mean APD (APDL) and were significantly shorter in the epicardium in the 26 wedges before ATX-II. ATX-II (≥5 nmol/l) prolonged APD heterogeneously (midmyocardium > endocardium > epicardium). The differences increased at longer CLs. ATX-II (20.0 nmol/l) shifted the APDL layer to 32 ± 6.2% (6 wedges, CL: 4,000 ms) of the transmural thickness from the (sub)endocardium (8.6 ± 7.2%, 26 wedges, ATX-II free). We detected the presence of M cell behavior (significantly longer APDs in the APDL layer than in the endocardium and epicardium, P ≤ 0.04, CL: 4,000 ms) in the 18 wedges having ≥5 nmol/l ATX-II but not ( P > 0.36) in the other 18 wedges having ≤2.5 nmol/l ATX-II. Both the position of the APDL layer and presence of M cell-like behavior were modulated by ATX-II. The dynamic spatial modulation indicates that M cell behavior is functional and only becomes manifest under suitable conditions.

Epicardial but not endocardial premature stimulation initiates ventricular tachyarrhythmia in canine in vitro model of long QT syndrome

OBJECTIVES

To explore the mechanism, we tested the hypothesis that premature epicardial stimulation transiently increased the dispersion of repolarization leading to VT.

BACKGROUND

Premature stimulation initiated ventricular tachycardia (VT) when applied to the epicardium but not to the endocardium in a canine model of long QT syndrome (LOTS).

METHODS

We optically mapped action potentials (APs) on the cut-exposed transmural surfaces of isolated wedges of canine ventricular walls perfused with anemone toxin II (ATX-II), which produced type 3 LQTS with an asymmetrical transmural profile of repolarization that was earliest in the epicardium and latest in deep subendocardium.

RESULTS

Earliest excitable epicardial stimulation triggered VT in 5 of 18 wedges receiving > or =5 nmol/L ATX-II by direct activation of epicardium, which delayed repolarization in the still refractory midmyocardium and further enhanced the dispersion of repolarization. These VTs were initiated 197 +/- 72 ms (n = 10) after the premature stimulation, from focal regions of earliest repolarization downstream to the steepest local spatial gradients of repolarization, and maintained by new focal activation and reentry. Transmural differences in the cycle lengths of activations altered conduction pathways and resulted in torsades de pointes-like polymorphic VT. In contrast, VTs were not initiated by endocardial stimulation at the same premature intervals or when ATX-II was < or =2.5 nmol/L. Failed VT initiation was associated with significantly lower maximum local gradient of repolarization.

CONCLUSIONS

Heterogeneic repolarization in LQTS provides a transmural asymmetrical substrate for the earliest excitable epicardial, but not endocardial, stimulation to further delay midmyocardial repolarization and produce a steep spatial gradient of repolarization potential initiating torsades de pointes-like polymorphic VT.

Optical imaging of the heart

Optical techniques have revolutionized the investigation of cardiac cellular physiology and advanced our understanding of basic mechanisms of electrical activity, calcium homeostasis, and metabolism. Although optical methods are widely accepted and have been at the forefront of scientific discoveries, they have been primarily applied at cellular and subcellular levels and considerably less to whole heart organ physiology. Numerous technical difficulties had to be overcome to dynamically map physiological processes in intact hearts by optical methods. Problems of contraction artifacts, cellular heterogeneities, spatial and temporal resolution, limitations of surface images, depth-of-field, and need for large fields of view (ranging from 2x2 mm2 to 3x3 cm2) have all led to the development of new devices and optical probes to monitor physiological parameters in intact hearts. This review aims to provide a critical overview of current approaches, their contributions to the field of cardiac electrophysiology, and future directions of various optical imaging modalities as applied to cardiac physiology at organ and tissue levels.

Effects of mechanical uncouplers, diacetyl monoxime, and cytochalasin-D on the electrophysiology of perfused mouse hearts

Chemical uncouplers diacetyl monoxime (DAM) and cytochalasin D (cyto-D) are used to abolish cardiac contractions in optical studies, yet alter intracellular Ca2+ concentration ([Ca2+]i) handling and vulnerability to arrhythmias in a species-dependent manner. The effects of uncouplers were investigated in perfused mouse hearts labeled with rhod-2/AM or 4-[β-[2-(di- n-butylamino)-6-naphthyl]vinyl]pyridinium (di-4-ANEPPS) to map [Ca2+]i transients (emission wavelength = 585 ± 20 nm) and action potentials (APs) (emission wavelength > 610 nm; excitation wavelength = 530 ± 20 nm). Confocal images showed that rhod-2 is primarily in the cytosol. DAM (15 mM) and cyto-D (5 μM) increased AP durations (APD75 = 20.0 ± 3 to 46.6 ± 5 ms and 39.9 ± 8 ms, respectively, n = 4) and refractory periods (45.14 ± 12.1 to 82.5 ± 3.5 ms and 78 ± 4.24 ms, respectively). Cyto-D reduced conduction velocity by 20% within 5 min and DAM by 10% gradually in 1 h ( n = 5 each). Uncouplers did not alter the direction and gradient of repolarization, which progressed from apex to base in 15 ± 3 ms. Peak systolic [Ca2+]i increased with cyto-D from 743 ± 47 ( n = 8) to 944 ± 17 nM ( n = 3, P = 0.01) but decreased with DAM to 398 ± 44 nM ( n = 3, P < 0.01). Diastolic [Ca2+]i was higher with cyto-D (544 ± 80 nM, n = 3) and lower with DAM (224 ± 31, n = 3) compared with controls (257 ± 30 nM, n = 3). DAM prolonged [Ca2+]i transients at 75% recovery (54.3 ± 5 to 83.6 ± 1.9 ms), whereas cyto-D had no effect (58.6 ± 1.2 ms; n = 3). Burst pacing routinely elicited long-lasting ventricular tachycardia but not fibrillation. Uncouplers flattened the slope of AP restitution kinetic curves and blocked ventricular tachycardia induced by burst pacing.

Contraction augments L-type Ca2+ currents in adherent guinea-pig cardiomyocytes

As integrins are thought to function as mechanoreceptors, we studied whether they could mediate mechanical modulation of the L-type Ca2+ channel current (ICa) in guinea-pig cardiac ventricular myocytes (CVMs). CVMs were voltage clamped with 280 ms pulses from -45 to 0 mV at 0.5 Hz (1.8 mM [Ca2+]o, 22 degrees C). Five minutes after whole-cell access (designated as 0 min) peak ICa was determined from a current-voltage (I-V) curve. Additional recordings were made after 5, 10 and 15 min. At control, ICa was not stable, but ran down during these periods. This run-down of ICa was attenuated by soluble fibronectin (FN) and was changed to an enhancement of ICa when CVMs were attached to FN-coated coverslips. Soluble peptide containing the integrin binding sequence of FN, Arg-Gly-Asp (RGD motif), did not modulate ICa; however, ICa increased in stimulated CVMs attached to RGD peptide-coated coverslips. The effect was not specific to integrins, because attachment to poly-D-lysine-coated coverslips also augmented ICa in stimulated CVMs. Augmentation of ICa by immobilized FN required rhythmical contraction of attached CVMs, because it was attenuated without electrical stimulation and after cell dialysis with the calcium chelator BAPTA. Furthermore, contraction-induced augmentation of ICa in FN-attached CVMs was sensitive to inhibition of protein kinase C (PKC; by Ro-31-8220), inhibition of tyrosine kinase activity (herbimycin A) and cytoskeletal depolymerization (cytochalasin D or colchicine). We attribute augmentation of ICa to the activation of signalling cascades by shear forces that are generated when CVMs contract against attachment; in vivo similar signals may occur when CVMs contract against attachment of integrins to the extracellular matrix.

Left atrial dilatation resulting from chronic mitral regurgitation decreases spatiotemporal organization of atrial fibrillation in left atrium

Atrial conduction properties have been shown to differ among animal atrial fibrillation (AF) models of rapid atrial pacing (RAP), chronic mitral regurgitation (MR), and control. We hypothesized that these conduction differences would continue with the onset of AF, which would affect AF spatiotemporal organization, resulting in model-specific characteristics of AF. With frequency domain analysis of electrograms acquired from high-density optical mapping, AF from the right (RA) and left (LA) atrium in animals with RAP and MR were compared with control animals. At follow-up, the hearts were excised and perfused, and optical action potentials were recorded from a 2 × 2-cm area each of the RA and LA free wall with a 16 × 16 photodiode array. AF was induced with extra stimuli, several 2.4-s AF episodes were recorded in each dog, and a fast Fourier transform was calculated. The dominant frequency (DF) was determined, and the organization (organization index, OI) was calculated as the ratio of the area under the dominant peak and its harmonics to the total area of the spectrum. All possible pairs of electrograms for each episode were cross-correlated. LA AF in the chronic MR model showed an increase in the highest DF, the number of DF domains, and in frequency gradient compared with AF in control or RAP models. In addition, there was a decrease in OI and in the correlation coefficients in the LA of the MR model. These results suggest that the AF substrate in the MR model may be different from that of control or RAP models.

Restitution Dynamics During Pacing and Arrhythmias in Isolated Pig Hearts

INTRODUCTION

The dependence of action potential duration (APD) on the preceding diastolic interval (DI), i.e., restitution, has been purported to predict the development of alternans and reentrant arrhythmias. However, restitution depends on the history of activation (i.e., memory), and its relevance to arrhythmia induction and maintenance is unknown.

METHODS AND RESULTS

Using a dual-camera video imaging system, we recorded action potentials from thousands of sites on the surface of the isolated pig heart. A steady-state pacing (SSP) protocol was performed to generate the SSP APD restitution curve. During SSP, the minimum DI and APD were 57 +/- 6 ms and 107 +/- 6 ms, respectively. The restitution slope was >1 for DIs <85 +/- 5 ms; however, alternans were not observed. Abrupt decreases in cycle length (CL) resulted in a rapid (<5 beats) decrease in APD followed by a slower decrease to "steady state." DI, APD pairs for the initial beats following these rate changes were significantly above the SSP restitution curve. DI, APD pairs measured during sustained ventricular fibrillation clustered significantly below the SSP restitution curve, at significantly shorter APDs (57 +/- 4 ms) and DIs (49 +/- 6 ms) than could be achieved during SSP. In addition, abrupt increases in CL following SSP resulted in APDs significantly shorter than those predicted from the SSP restitution curve.

CONCLUSION

Our results indicate that the responses of APD and DI to sudden rate changes and during arrhythmias are not predicted by the SSP restitution relationship. Acute dynamics act to damp out the proarrhythmic oscillations predicted from the SSP restitution curve.