Local Functional and Structural Changes in the Myocardium During Ventricular Pacing

Interpreting voltage-sensitivity of gap junctions as a mechanism of cardiac memory

Memory in the nervous system is essentially a network effect, resulting from activity-dependent synaptic modification in a network of neurons. Like the nervous system, the heart is a network of cardiac cells electrically coupled by gap junctions. The heart too has memory, termed cardiac memory, whereby the effect of an external electrical activation persists long after the presentation of stimulus is terminated. We have earlier proposed that adaptation of gap junctions, as a function of membrane voltages of the cells that are coupled by the gap junctions, is related to cardiac memory [V.S. Chakravarthy, J. Ghosh, On Hebbian-like adaption in heart muscle: a proposal for "Cardiac Memory", Biol. Cybern. 76 (1997) 207, J. Krishnan, V.S. Chakravarthy, S. Radhakrishnan, On the role of gap junctions on cardiac memory effect, Comput. Cardiol. 32 (2005) 13]. Using the proposed mechanism, we demonstrate memory effect using computational models of interacting cell pairs. In this paper, we address the biological validity of the proposed mechanism of gap junctional adaptation. It is known from electrophysiology of gap junctions that the conductance of these channels adapts as a function of junctional voltage. At a first sight, this form of voltage dependence seems to be at variance with the form required by our mechanism. But we show, with the help of a theoretical model, that the proposed mechanism of voltage-dependent adaptation of gap junctions, is compatible with the known voltage-sensitivity of gap junctions observed in electrophysiological studies. Our analysis suggests a new significance of the voltage-sensitivity of gap junctions and its possible link to the phenomenon of cardiac memory.

Pacing-induced electrophysiological remodeling in hypertrophic obstructive cardiomyopathy--observations on cardiac memory

BACKGROUND

Hypertrophic cardiomyopathy carries an increased risk for sudden cardiac death. While pacing therapy reduces the left ventricular outflow tract gradient and improves symptoms in a subgroup of hypertrophic obstructive cardiomyopathy (HOCM) patients, its electrophysiological consequences are unknown and were therefore assessed in this prospective study.

METHODS AND RESULTS

Fifteen consecutive HOCM patients were studied and compared with 14 patients without HOCM paced because of sinus bradycardia. ECG intervals were measured before pacemaker implantation and after > or =3 months of DDD pacing in HOCM patients and > or =5 weeks in controls. Both groups showed similar ECG signs of cardiac memory development. In HOCM patients, with baseline QTc 447 +/- 33 ms, cardiac memory development was not associated with any significant changes in ECG intervals. In contrast, baseline repolarization in control patients was significantly prolonged by 6% (QTc 429 +/- 33 vs 454 +/- 46 ms; P < 0.05). Furthermore, in HOCM patients repolarization was 7% shorter during DDD pacing compared to sinus rhythm (JTc 329 +/- 25 vs 353 +/- 21 ms; P < 0.05), despite a significantly prolonged ventricular activation time (QRS duration 155 +/- 16 vs 91 +/- 9 ms; P < 0.01).

CONCLUSIONS

Importantly, the development of cardiac memory-induced different repolarization responses depending on baseline structure and electrophysiology. In HOCM patients repolarization was shorter during right ventricular apical pacing than during normal activation despite prolonged activation time.

New approaches to antiarrhythmic therapy, Part I: emerging therapeutic applications of the cell biology of cardiac arrhythmias

Cardiac arrhythmias complicate many diseases affecting the heart and circulation, and they incorporate a multiplicity of underlying mechanisms. The evolution of scientific knowledge has made the complex changes produced by cardiovascular disease sufficiently understood at the organ, cellular, and molecular levels such that there is a diversity of therapeutic targets for pharmacological therapy and/or prevention. Moreover, the approach of rational drug design in mechanism-specific and disease-specific fashions facilitates the targeting of therapy using the methods of molecular, structural, and translational biology. Additional approaches, using similar drug design strategies but based on gene therapy and transcriptional and translational modification, are on the horizon. Hence, there is reason to be optimistic regarding the design, testing, and clinical availability of novel antiarrhythmic therapies.