Cable analysis in quiescent and active sheep Purkinje fibres

Stimulation and propagation of activation in conduction tissue: Implications for left bundle branch area pacing

BACKGROUND

Characterizing wavefront generation and impulse conduction in left bundle (LB) has implications for left bundle branch area pacing (LBBAP).

OBJECTIVES

The purpose of this study was to describe the pacing characteristics of LB and to study the role of pacing pulse width (PW) in overcoming left bundle branch block.

METHODS

Twenty fresh ovine heart slabs containing well-developed and easily identifiable tissues of the conduction system were used for the study. LB stimulation, activation, and propagation were studied under baseline conditions, simulated conduction slowing, conduction block, and fascicular block.

RESULTS

The maximum radius of the LB early activation increased up to 13.4 ± 2.4 mm from the pacing stimulus, and the time from stimulus to evoked potential shortened when pacing PW was increased from 0.13 to 2 ms at baseline. Conduction slowing and block induced by cooling could be resolved by increasing pacing PW from 0.25 to 1.5 ms over a distance of 10 ± 1.5 mm from the pacing stimulus. The LB strength-duration (SD) curve was shifted to the left of the myocardial SD curve.

CONCLUSION

Increasing PW resolved conduction slowing and block and bypassed the experimental model of fascicular block in LB. Precise positioning of the LB lead in left ventricular subendocardium is not mandatory in LBBAP, as the SD curve of LB was shifted to the left of the myocardium SD curve and could be captured from a distance by optimizing PW.

MEMBRANE AND TISSUE LEVEL CONTRIBUTIONS TO PURKINJE-VENTRICULAR INTERACTIONS: A MODEL STUDY

Purkinje-to-ventricular (P-to-V) propagation and electrotonic modulation of repolarization at discrete Purkinje-ventricular junctions (PVJs) depend on differences in the ionic currents and tissue structure of the P network and the V myocardium. We used computer simulations to assess these membrane and tissue level contributions to P-V interactions. At the membrane level, we used the DiFrancesco-Noble membrane equations to model P ionic kinetics and the Luo-Rudy dynamic membrane equations to model V ionic kinetics. At the tissue level, we modeled the P network as a layer of branching cables, and we modeled a single myocardial sheet with an anisotropic layer of excitable cells. P-to-V propagation was enhanced at the tissue level when multiple wavefronts in the branching P network collided at the PVJ. At the membrane level, P-to-V propagation was enhanced by a reduced transient outward current (Ito) in the P layer. Repolarization at the PVJ was also modulated by both membrane and tissue level contributions. Under nominal conditions, action potential duration (APD) shortened in the P layer and prolonged in the V layer. However, when the V mass was reduced, both P and V cell APDs shortened during coupling with nominal Ito. Subsequent Ito inhibition restored coupling-induced prolongation of the V action potential in the reduced V mass. These results suggest that under physiologic conditions, both membrane and tissue level contributions to P-V interactions are important, while membrane level contributions become even more important under pathologies that reduce the difference in P and V tissue size, particularly in the setting of healed myocardial infarction.

The sensitivity of the heart to static magnetic fields

Static magnetic fields induce flow potentials in arterial flows in and around the heart, that have been detected as distortions in the ECG. The resultant currents flowing through the myocardium could alter the rate or rhythm of the heart. No such changes have been seen in animal experiments, or with humans, in static fields up to 8 T. The possible effects of such currents induced by fields larger than 8 T on cardiac pacemaker rate, and arrhythmogenesis are reviewed, using virtual cardiac tissues-computational models of cardiac electrophysiology. Arrhythmogenesis can be by the initiation of ectopic beats, or by re-entry, whose probability of occurrence is increased by any increase in the electrical heterogeneity, in particular, the action potential duration heterogeneity of the ventricle. Focal ectopic activity would be readily detectable, but since re-entrant arrhythmias are very rare events, even a large increase in their probability of occurrence still leaves them unlikely to be observed. Both of these two arrhythmogenic mechanisms would show a steep sigmoidal, or threshold dependence on induced current intensity, with the threshold for increasing the vulnerability to re-entry less than the threshold for initiating activity. Failure to observe them at fields less than 8 T provides only a lower bound for any threshold for arrhythmogenesis.

Role of the carboxyl terminal of connexin43 in transjunctional fast voltage gating

Previous studies show that chemical regulation of connexin43 (Cx43) gap junction channels depends on the integrity of the carboxyl terminal (CT) domain. Experiments using Xenopus oocytes show that truncation of the CT domain alters the time course for current inactivation; however, correlation with the behavior of single Cx43 channels has been lacking. Furthermore, whereas chemical gating is associated with a "ball-and-chain" mechanism, there is no evidence whether transjunctional voltage regulation for Cx43 follows a similar model. We provide data on the properties of transjunctional currents from voltage-clamped pairs of mammalian tumor cells expressing either wild-type Cx43 or a mutant of Cx43 lacking the carboxyl terminal domain (Cx43M257). Cx43 transjunctional currents showed bi-exponential decay and a residual steady-state conductance of approximately 35% maximum. Transjunctional currents recorded from Cx43M257 channels displayed a single, slower exponential decay. Long transjunctional voltage pulses caused virtual disappearance of the residual current at steady state. Single channel data revealed disappearance of the residual state, increase in the mean open time, and slowing of the transition times between open and closed states. Coexpression of CxM257 with Cx43CT in a separate fragment restored the lower conductance state. We propose that Cx43CT is an effector of fast voltage gating. Truncation of Cx43CT limits channel transitions to those occurring across the higher energy barrier that separates open and closed states. We further propose that a ball-and-chain interaction provides the fast component of voltage-dependent gating between CT domain and a receptor affiliated with the pore.

Purkinje and ventricular contributions to endocardial activation sequence in perfused rabbit right ventricle

Interactions between peripheral conduction system and myocardial wave fronts control the ventricular endocardial activation sequence. To assess those interactions during sinus and paced ventricular beats, we recorded unipolar electrograms from 528 electrodes spaced 0.5 mm apart and placed over most of the perfused rabbit right ventricular free wall endocardium. Left ventricular contributions to electrograms were eliminated by cryoablating that tissue. Electrograms were systematically processed to identify fast (P) deflections separated by >2 ms from slow (V) deflections to measure P-V latencies. By using this criterion during sinus mapping (n = 5), we found P deflections in 22% of electrograms. They preceded V deflections at 91% of sites. Peripheral conduction system wave fronts preceded myocardial wave fronts by an overall P-V latency magnitude that measured 6.7 +/- 3.9 ms. During endocardial pacing (n = 8) at 500 ms cycle length, P deflections were identified on 15% of electrodes and preceded V deflections at only 38% of sites, and wave fronts were separated by a P-V latency magnitude of 5.6 +/- 2.3 ms. The findings were independent of apical, basal, or septal drive site. Modest changes in P-V latency accompanied cycle length accommodation to 125-ms pacing (6.8 +/- 2.6 ms), although more pronounced separation between wave fronts followed premature stimulation (11.7 +/- 10.4 ms). These results suggested peripheral conduction system and myocardial wave fronts became functionally more dissociated after premature stimulation. Furthermore, our analysis of the first ectopic beats that followed 12 of 24 premature stimuli revealed comparable separation between wave fronts (10.7 +/- 5.5 ms), suggesting the dissociation observed during the premature cycles persisted during the initiating cycles of the resulting arrhythmias.

Optical mapping of cardiac electrical stimulation

Optical mapping has been used to determine changes in transmembrane voltage during electrical stimulation pulses (deltaVm) and whether deltaVm depends on fiber orientation, as predicted from bidomain models. Fiber orientation in an approximately 1 cm2 mm mapped region on the rabbit left or right ventricular epicardium was estimated optically from the fast axis of action potential (AP) propagation. Hearts were paced outside of the region to produce APs. Unipolar stimulation (S2) was then applied early in the AP, when tissue was refractory, so that deltaVm was not obscured by a new AP. Anodal S2 produced negative deltaVm near a point S2 electrode and away from it in the direction perpendicular to the fibers. Anodal S2 produced reversal of the sign of deltaVm about 1 mm from the electrode in the direction parallel to the fibers, such that a positive deltaVm existed about 1-5 mm away from the electrode. Reversal of the sign of deltaVm in the direction parallel to the fibers also occurred with cathodal S2, which produced a negative deltaVm away from the electrode parallel to the fibers. The results indicate a "dogbone" pattern of deltaVm, as predicted from bidomain models that have resistance anisotropy ratios of trabecular muscles (ie, an intracellular ratio that does not equal the extracellular ratio). Thus, optical mapping can indicate fiber orientation and deltaVm, and the deltaVm during unipolar stimulation reverses sign on the axis parallel to the fibers, which differs from one-dimensional model predictions. The deltaVm agrees with multidimensional bidomain model predictions that have unequal resistance anisotropy.

Flecainide and the electrophysiologic matrix: the effects of flecainide acetate on the determinants of cardiac excitability in sheep Purkinje fibers

Flecainide was associated with excess mortality distributed virtually equally throughout the period of the Cardiac Arrhythmia Suppression Trial, suggesting the intersection of two events, drug effect and perhaps ischemia. Flecainide's effect on active properties has been studied extensively, but nothing is known of its effects on passive properties or on the balance among active and passive cellular properties that determines cardiac excitability. The multiple microelectrode method of intracellular current application and transmembrane voltage recording was used in sheep Purkinje fibers to determines strength- and charge-duration as well as constant current-voltage relationships and to estimate active properties, liminal length, and cable properties at a normal [K+]o and in a setting of hyperkalemia analogous to that of ischemia. A computer tracked in time the alterations in the active and passive properties relevant to excitability. Flecainide slightly decreased excitability at a normal [K+]o, primarily by depressing the sodium system with some contributory effect of passive properties. At high [K+]o, flecainide caused a frequency-dependent decrease in excitability and conduction, the latter best interpreted as a failure of the fiber to attain the liminal length requirements to produce a local action potential due primarily to an effect on sodium conductance. Together, the observations suggest that the action potential is the local phenomenon and that the propagated event is the sequential fulfillment of liminal length requirements. The data were interpreted in terms of the electrophysiologic matrix first proposed in detail in this Journal, which indicated that the electrophysiologic universe moved as a system in response to the drug and a change in [K+]o, the presumed antiarrhythmic and proarrhythmic electrophysiologic matrices for flecainide were quite similar, and the matrical configuration shared characteristics with the matrices of other drugs with known proarrhythmic potential.

Transmembrane voltage changes during unipolar stimulation of rabbit ventricle

This study tested the prediction of bidomain models that unipolar stimulation of anisotropic myocardium produces transmembrane voltage changes (delta VmS) of opposite signs away from the electrode on perpendicular axes. Stimulation with a strength of 0.1 to 40 mA was applied from a point electrode on the left or right ventricle of isolated perfused rabbit hearts at 37 degrees C to 38 degrees C stained with the potentiometric dye di-4-ANEPPS. A laser scanner system recorded Vm-sensitive fluorescence at 63 spots in an 8 x 8-mm region around the electrode. Cathodal stimulation in the refractory period produced regions of -delta Vm 1 to 5 mm away from the electrode on an axis oriented parallel to the fast propagation axis to within 1.8 +/- 11 degrees (P > or = .7 for difference versus zero, n = 7). Recording spots in these regions underwent + delta Vm when anodal stimulation was used. At recording spots on the slow propagation axis, cathodal stimulation produced + delta Vm and anodal stimulation produced -delta Vm. During diastolic stimulation, early excitation occurred near the electrode for cathodal stimulation or on the fast propagation axis as fas as 2.8 +/- 1 mm away from the electrode for anodal stimulation. A "dog-bone" region of + delta Vm that included tissue near and away from the electrode on the slow propagation axis occurred when cathodal stimulation was given in diastole. Regions of + delta Vm occurred away from the electrode on the fast propagation axis when anodal stimulation was given in diastole. Thus, delta Vm differs in regions along and across myocardial fibers, indicating that delta Vm depends on anisotropic bidomain properties. Sites of early excitation are those where + delta Vm occurs, indicating that membrane channel excitation depends on the distribution of delta Vm.

Simulations of passive properties and action potential conduction in an idealized bullfrog atrial trabeculum

This study investigates the properties of a distributed parameter model of an idealized trabeculum of cardiac muscle surrounded by a resistive-capacitive trabecular sheath. A mathematical approach is developed that permits the direct solution for the absolute potential in each medium [i.e., the intracellular (Vi), interstitial (Ve), and external (Vo) potentials), as opposed to obtaining solutions for the transmembrane potential V (where V identical to Vi-Ve). The mathematical description of the underlying individual cell is based upon quantitative whole-cell voltage-clamp measurements in bullfrog atrial myocytes. "Reduced" or "simplified" cell membrane models that lack the complete complement of transmembrane currents are compared with regard to their accuracy in representing the root, upstroke, and plateau regions of the propagated action potential in the complete model. The results show that a reduced cell membrane model must contain the sodium current INa, calcium current ICa, and background-rectifying K+ current IK1. A cell membrane model that contains a linear background K+ current IL instead of IK1 results in much poorer approximation to the upstroke, plateau, and conduction velocities of an action potential. The effects of varying the resistive-capacitive parameters of the trabecular sheath on both the passive properties (the time and space constants and the input resistance) and conduction parameters (time and space constants of the foot and conduction velocity of the action potential) of the trabeculum are also investigated. These simulations show that electrical activity within the trabeculum is much more sensitive to variations in the resistive component than in the capacitive component of the sheath. The trabecular sheath reduces the extracellular resistance seen by the cell by shunting current away from highly resistive interstitial medium into the volume conductor medium, which is of low resistance, and thereby increases conduction velocity. Finally, the addition of the cholinergic neurotransmitter acetylcholine to the extracellular medium reduces both the space constant of the trabeculum and the conduction velocity of propagated electrical activity.

Unidirectional block between isolated rabbit ventricular cells coupled by a variable resistance

We have used pairs of electrically coupled cardiac cells to investigate the dependence of successful conduction of an action potential on three components of the conduction process: (a) the amount of depolarization required to be produced in the nonstimulated cell (the "sink" for current flow) to initiate an action potential in the nonstimulated cell, (b) the intercellular resistance as the path for intercellular current flow, and (c) the ability of the stimulated cell to maintain a high membrane potential to serve as the "source" of current during the conduction process. We present data from eight pairs of simultaneously recorded rabbit ventricular cells, with the two cells of each pair physically separated from each other. We used an electronic circuit to pass currents into and out of each cell such that these currents produced the effects of any desired level of intercellular resistance. The cells of equal size (as assessed by their current threshold and their input resistance for small depolarizations) show bidirectional failure of conduction at very high values of intercellular resistance which then converts to successful bidirectional conduction at lower values of intercellular resistance. For cell pairs with asymmetrical cell sizes, there is a large range of values of intercellular resistance over which unidirectional block occurs with conduction successful from the larger cell to the smaller cell but with conduction block from the smaller cell to the larger cell. We then further show that one important component which limits the conduction process is the large early repolarization which occurs in the stimulated cell during the process of conduction, a process that we term "source loading."

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.

Virtual cathode effects during stimulation of cardiac muscle. Two-dimensional in vivo experiments

We have found that when suprathreshold cathodal stimuli were applied to the epicardium of canine ventricle, impulse propagation originated at a "virtual cathode" with dimensions greater than those of the physical cathode. We report the two-dimensional geometry of the virtual cathode as a function of stimulus strength; the results are compared with the predictions of an anisotropic, bidomain model of cardiac conduction recently developed in our laboratories. Data were collected in six pentobarbital-anesthetized dogs by using a small plaque electrode sewn to the left ventricular epicardium. Arrival times at closely spaced bipolar electrodes oriented radially around a central cathode were obtained as a function of stimulus strength and fiber orientation. The dimensions of the virtual cathode were determined by linear back-extrapolation of arrival times to the time of stimulation. The directional dependence of the conduction velocity was consistent with previous reports: at 1 mA, longitudinal (0 degree) and transverse (90 degrees) velocities were 0.60 +/- 0.03 and 0.29 +/- 0.02 m/sec, respectively. At 7 mA, the longitudinal velocity was 0.75 +/- 0.05 m/sec, whereas there was no significant change in the transverse velocity. In contrast to conduction velocity, the virtual cathode was smallest in the longitudinal orientation and largest between 45 degrees and 60 degrees. Virtual cathode size was dependent on both orientation and stimulus strength: at 0 degree, the virtual cathode was small (approximately 1 mm) and relatively constant over the range of 1-7 mA; at oblique orientations (45 degrees-90 degrees), it displayed a roughly logarithmic dependence on stimulus strength, approximately 1 mm at 1 mA and approximately 3 mm at 7 mA. The bidomain, anisotropic model reproduced both the stimulus strength and the fiber-orientation dependence of the virtual cathode geometry when the intracellular and extracellular anisotropies were 10:1 and 4:1, respectively, but not when the two anisotropies were equal. We suggest that the virtual cathode provides a direct measure of the determinants of cardiac activation; its complex geometry appears to reflect the bidomain, anisotropic nature of cardiac muscle.

Modulation of collision-induced changes in canine heart repolarization by cycle length

The possibility that cycle length modulates the electronic effect of activation sequence on repolarization was investigated in experiments using isolated canine cardiac Purkinje strands, in situ canine ventricular myocardium, and computer simulations. Action potential durations and refractory periods during one-way propagation were compared to those obtained during action potential collision. In both the computer simulations and the Purkinje strand experiments, collision decreased action potential duration more at long cycle lengths than at short cycle lengths. Comparably, collision of activation fronts in ventricular myocardium was associated with greater reductions in refractory period during pacing at long cycle lengths than at short cycle lengths. Theoretic considerations indicate that the magnitude of electrotonic effects of activation sequence on repolarization are directly related to action potential height and the square root of membrane resistance during repolarization and are inversely related to conduction velocity. In computer simulations and Purkinje strand experiments, changes in conduction velocity and action potential height elicited by decreasing cycle length could not fully account for the cycle length dependence of collision-induced changes in repolarization. Time-varying membrane resistance of a single cell was calculated in the simulations by briefly hyperpolarizing the membrane and determining the change in total ionic current. Membrane resistance during repolarization was less at short cycle lengths than at long cycle lengths. The results suggest the cycle length dependence of collision-induced changes in repolarization results largely from the effect of cycle length on membrane resistance during action potential repolarization, with changes in action potential height and conduction velocity playing a lesser role.

The construction of an anatomically based model of the human ventricular conduction system

The ventricular conduction system is a complicated network of specialized muscle cells responsible for the transmission of electrical activity between the atria and the ventricles of the human heart. It has been the focus of numerous electrical and anatomical studies at both the microscopic and macroscopic levels. An understanding of its behavior at both levels is considered important, because it is primarily responsible for the spread of excitation in the ventricles. Previous computer models have been very simple ones that have been primarily adjuncts to models of the ventricles. This paper describes a strategy for the construction of conduction system models which is based on real microscopic and macroscopic features, although the model still is much simpler than reality. The model contains almost 35,000 individual cylindrical elements, each of whose physical dimensions approximate unit bundles of Purkinje and atrioventricular nodal cells. The model, whose physical appearance closely resembles that of the conduction system, was generated from limited anatomical data in less than 2 min CPU time on an IBM 3090 at the Cornell National Supercomputer Facility.

Influence of rate-dependent cellular uncoupling on conduction change during simulated ischemia in guinea pig papillary muscles: effect of verapamil

This study was performed to determine if the changes in cellular coupling induced by simulated ischemia were rate-dependent and if they contributed to the rate-dependent conduction slowing that occurs in this setting. We also sought to determine if the known ability of verapamil to prevent ischemia-induced conduction changes might be related to the preservation of cellular coupling. We studied the effects of increasing stimulation frequency from 0.5 to 2.0 Hz on the simultaneous changes in the maximum rate of rise (Vmax) of the action potential upstroke, conduction velocity, and internal longitudinal resistance (ri) determined by the voltage ratio method in superfused guinea pig papillary muscles under conditions of simulated ischemia (SI). When stimulation frequency was 0.5 Hz, 30 minutes of SI caused a 16.5% decrease in Vmax, a 16% increase in ri, and a 12.9% decrease in conduction velocity. When stimulation frequency was increased to 2.0 Hz, 30 minutes of SI caused a 30% decrease in Vmax, a 72.9% increase in ri, and a 21.4% decrease in conduction velocity. Thus, the changes were rate-dependent. Verapamil (1 X 10(-6) M) did not influence the changes in these parameters during SI at 0.5 Hz nor the decrease in Vmax during SI at 2.0 Hz, but it did prevent the rate-dependent increase in ri. Verapamil also prevented the rate-dependent decrease in conduction velocity induced by SI. Our results suggest that during simulated ischemia the rate-dependent component of the increase in Ri contributes to the rate-dependence of the conduction slowing.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracellular pH and cell-to-cell transmission in sheep Purkinje fibers

Intracellular pH (pHi) is a significant modifier of cell-to-cell communication in some tissues but its role is uncertain in heart tissue. The present studies examined the effect of cytosolic protons on electrotonic spread and conduction velocity in cardiac Purkinje fibers. Cable analysis provided values for internal longitudinal resistance (ri) and pH-selective microelectrodes monitored pHi during CO2 and HCO3- alterations. Resting fibers developed changes in ri that were proportional to intracellular free proton concentration ([H+]i) during CO2 changes at constant [HCO3-]. However, the effects on ri were small between pHi 6.9-7.8 and predicted only a 2.2% increase in ri per 10 nM increase in [H+]i. Other findings suggested that titration of cytosolic protons may not directly produce the changes in ri: (a) For an equal change in [H+]i, the effects on ri were roughly three times greater (6.8% increase per 10 nM rise in [H+]i) if bicarbonate was lost during CO2 changes. (b) pH-associated changes in ri were preceded by a time delay (1-5 min) producing hysteresis in the [H+]i-ri relation during successive perturbations. (c) The same CO2 variations modified the direction and magnitude of ri differently during pacing than at rest. The cumulative results suggest that the action of protons on ri in the heart may be subordinate to another regulator or mediated by another pH-dependent substance or reaction.

Rate-dependent effects of hypoxia on internal longitudinal resistance in guinea pig papillary muscles

We have studied the independent and combined effects of 30 minutes' exposure to hypoxia and an increase in stimulation frequency from 0.5 Hz to 3.0 Hz on internal longitudinal resistance (ri) and conduction in guinea pig papillary muscles through the use of the voltage ratio method with air as the external insulator. Increasing stimulation frequency from 0.5 to 3.0 Hz in the presence of O2 caused no significant change in ri. Hypoxia to a level of PO2 = 30 mm Hg caused an increase in ri that averaged 13.7% at a stimulation frequency of 0.5 Hz and 46% at 3.0 Hz. In all experiments, the increase in ri during hypoxia at 3.0 Hz was greater than the increase at 0.5 Hz, but conduction velocity did not change at either rate. These results indicate that hypoxia causes rate-dependent cellular uncoupling but, under the conditions of our experiments, does not cause significant changes in conduction.

Overdrive suppression of conduction at the canine Purkinje-muscle junction

We have shown previously that overdrive suppression of conduction in depolarized His-Purkinje tissue requires conduction asymmetry. In this study we examined whether overdrive suppression of conduction can occur at the Purkinje-muscle junction, where natural asymmetry of conduction exists. Canine Purkinje-muscle preparations were superfused with hyperkalemic Tyrode's solution (KCl 8 to 12 mM), and action potentials were recorded from Purkinje, junctional, and muscle cells. Initially, the Purkinje fiber was paced at the shortest cycle length at which 1:1 anterograde Purkinje-muscle conduction occurred. The papillary muscle then was paced for 10 to 50 beats at shorter cycle lengths during which, because of conduction asymmetry at the Purkinje-muscle junction, 1:1 retrograde muscle-Purkinje conduction also occurred. After overdrive papillary muscle pacing, Purkinje fiber pacing at the same cycle length that previously resulted in 1:1 conduction now produced transient Purkinje-muscle conduction block (overdrive suppression of conduction). The degree and duration of overdrive suppression of conduction were proportional to the rate and duration of overdrive pacing. After overdrive pacing, Purkinje cell action potential amplitude and Vmax recovered within 300 msec, yet conduction block persisted for up to 7 sec. In contrast, excitability in papillary muscle cells near the Purkinje-muscle junction increased continuously after overdrive pacing. These data suggest that rapid activation of Purkinje cells during overdrive pacing was not required for overdrive suppression of conduction and that restoration of conduction after overdrive pacing was determined primarily by recovery of excitability in papillary muscle cells. Transient Purkinje-muscle conduction block after periods of rapid ventricular rates might account for overdrive-induced conduction disturbances normally attributed to bundle branch block.

The conduction of the cardiac impulse 1951-1986

The study of the propagation of the cardiac impulse during the last 35 years is reviewed with special attention to the contributions of Silvio Weidmann and his colleagues. Special emphasis is placed on the need to prove that the cardiac impulse is transmitted electrically, even when it is conducted under very abnormal conditions.

Conduction over an isthmus of atrial myocardium in vivo: a possible model of Wolff-Parkinson-White syndrome

Antiarrhythmic drugs appear preferentially to prolong refractoriness of accessory pathways compared with atrial or ventricular muscle in patients with the Wolff-Parkinson-White syndrome. This response may be due to intrinsic properties of accessory pathways or to depressed conduction associated with a narrow strip, or isthmus, of tissue. To test the latter possibility, in 16 anesthetized dogs we surgically isolated a portion of the right atrial myocardium in the form of an ellipse (10 to 25 X 8 to 15 mm). The ellipse was connected to the body of the right atrium by a narrow isthmus (cross-sectional area [CSA] 1 to 13.5 mm2) and was perfused by the sinus node artery or its branch. Diastolic threshold (mean +/- SE 0.16 +/- 0.05 vs 0.13 +/- 0.02 mA) and effective refractory period (ERP; 144 +/- 4 vs 139 +/- 5 msec) were the same proximal and distal to the isthmus. In eight dogs, determination of the ERP of the isthmus was limited by the ERP of the atrial tissue proximal and distal to the isthmus, and the CSA of the isthmus in these dogs was significantly larger than that in the remaining seven dogs in which the ERP of the isthmus could be determined (7.4 +/- 1.4 vs 3.2 +/- 0.6 mm2, p less than .05). The shortest pacing cycle length (PCL) with 1:1 conduction from the proximal to the distal segments did not differ from that in the opposite direction in 16 dogs (154 +/- 9 vs 153 +/- 7 msec). The CSA of the isthmus correlated inversely with the shortest PCL with 1:1 conduction in both directions via the isthmus (r = -.84, p less than .01). Vagal stimulation shortened the shortest PCL with 1:1 conduction from the distal to the proximal segment (153 +/- 14 vs 143 +/- 12 msec, p less than .02), but not in the opposite direction. Procainamide (10 to 20 mg/kg iv, serum concentration 8.6 +/- 0.8 micrograms/ml) prolonged the ERP of the proximal site from 145 +/- 5 to 170 +/- 5 msec (p less than .001), the ERP of the distal site from 143 +/- 6 to 168 +/- 6 msec (p less than .001) in 12 dogs, and the shortest PCL with 1:1 conduction (proximal to distal from 149 +/- 8 to 204 +/- 17 msec, p less than .001; distal to proximal from 149 +/- 7 to 197 +/- 12 msec, p less than .001) in 14 dogs.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrical constants of arterially perfused rabbit papillary muscle

1. Right ventricular rabbit papillary muscles were arterially perfused with a mixture of Tyrode solution, bovine erythrocytes, dextran and albumin. In the recording chamber, they were surrounded by a H2O-saturated atmosphere of O2 and CO2 which served as an electrical insulator. 2. Conduction velocity and passive electrical properties were determined from intra- and extracellular potentials measured during excitation and during flow of subthreshold current. 3. The propagation of the action potential was linear along the muscle at a velocity of 55.6 cm/s. The extracellular wave-front voltage was 51.5 mV. 4. The following values for passive cable properties were obtained: (i) a ratio of extra- to intracellular longitudinal resistance of 1.2; (ii) an extracellular specific resistance (Ro) of 63 omega cm; (iii) an intracellular specific resistance (Ri) of 166 omega cm; (iv) a space constant lambda of 0.357 mm; (v) a membrane time constant tau of 2.57 ms. The space constant lambda* recalculated for zero extracellular resistance was 0.528 mm. 5. Arresting perfusion with drop of perfusion pressure was associated with an immediate increase of the extracellular longitudinal resistance by 35% and a decrease of conduction velocity by 13%. 6. The present results demonstrate the important contribution of the extracellular resistance to electrotonic interaction and propagation in densely packed myocardial tissue. Moreover, changes in perfusion pressure are associated with changes in extracellular resistance, probably as a consequence of changes in intravascular volume.

Cardiac cellular electrophysiology: past and present

The time-course of the cardiac action potential can be accounted for in terms of ionic currents crossing the cell membranes. Depolarizing current is carried by Na+ or Ca2+ entering the cells, repolarizing current by K+ leaving the cells. Membrane permeability for the passive movement of these ions is thought to be voltage-dependent as well as time-dependent. Net transfer of charge may also result from active transport, 2 Na+ out against 1 K+ in; or coupled exchange, 3 or 4 Na+ in against 1 Ca2+ out. This review follows the path by which present-day knowledge has been reached. It also gives a few examples to illustrate that electrophysiology has provided concepts useful to clinical cardiology.

Effects of hypoxia, hyperkalemia, and metabolic acidosis on canine subendocardial action potential conduction

We have studied the individual and combined effects of elevated external potassium concentration (8 mM [K+], metabolic acidosis (pH = 6.8), and hypoxia at different stimulation 400 milliseconds) on Purkinje (P) and ventricular (V) conduction velocities and on Purkinje-ventricular junctional conduction delay (PVJ delay) in in vitro preparations from canine ventricles. Elevated [K+] had opposite effects on P and V velocities, increasing V velocity by 8% while reducing P velocity by 7%. Acidosis reduced P velocity by 9% while reducing V velocity by only 4%. Hypoxia and rapid stimulation rates had no significant effect on either P or V velocities. All test solutions (except hypoxia alone) significantly increased the PVJ delay. The magnitude of the increase in PVJ delay was much greater than the effects on either P or V velocity. In addition, hypoxia and rapid stimulation augmented the increase in PVJ delay in the presence of elevated [K+] and/or acidosis. The special features of conduction at the PV junctional sites may produce altered pathways of excitation of the ventricles during myocardial ischemia.

Comparative aspects of the dual role of the human atrioventricular node

As well as transmitting the impulse from the atria to the ventricles the atrioventricular node has two other important functions namely: synchronisation of atrial and ventricular contractions by a varying delay; and protection of the ventricles from rapid atrial arrhythmias. The relative importance of these two functions appears to differ in large and small mammalian hearts. In small mammals synchronisation of atrial and ventricular contractions is the major function of the atrioventricular node, whereas protection from rapid atrial arrhythmias may be its most important function in large mammals. Atrioventricular conduction time in sinus rhythm is ten times longer in the whale (500 ms) than in the rat (50 ms). A whale heart, however, is about 100 000 times heavier than a rat heart. During atrial fibrillation the ventricular rate in a dog heart is only three times faster than in a horse, whereas a horse heart may be 40 times as heavy as that of a dog. Hence there is a considerable discrepancy between the size of the mammalian heart and the functions of its atrioventricular node. Analysis of several anatomical and functional aspects of atrioventricular conduction systems in mammals of all sizes showed that the importance of the delaying role of the atrioventricular conduction system diminishes as the size of the mammal increases, whereas the protective role of the atrioventricular node probably increases. The function of the human atrioventricular node seems to be intermediate between that of of the small and large mammals.

Electrophysiological mechanisms underlying rate-dependent changes of refractoriness in normal and segmentally depressed canine Purkinje fibers. The characteristics of post-repolarization refractoriness

Tissues from diseased hearts are known to exhibit post-repolarization refractoriness and rate-dependent changes of the refractory period that are often inconsistent with changes in action potential duration. To examine the electrophysiological mechanisms responsible for such rate-dependent changes of the refractory period, a narrow inexcitable zone was created by superfusing the central segments of Purkinje fibers with an "ion-free" isotonic sucrose solution. The degree of conduction impairment could be finely regulated by varying the resistance of the extracellular shunt pathway. At intermediate or low levels of block, the refractory period remained unchanged or decreased, respectively, as the rate was increased. At relatively high levels of block, however, we observed marked increases of the refractory period in response to increases in the stimulation rate. The disparity of refractoriness between normally conducting fibers and fibers exhibiting discontinuous conduction characteristics and post-repolarization refractoriness increased dramatically as a function of increasing stimulation rate. With the aid of current clamp techniques, we demonstrate that the differential behavior is due to the interplay between rate-dependent changes in the restitution of excitability at the site beyond the depressed zone secondary to changes in passive and active membrane properties and in the intensity of local circuit current provided to that site by activity generated in the segment proximal to the zone of block. Our data suggest that rate-dependent changes of refractoriness in Purkinje tissue are principally governed by attendant changes in membrane resistance.

Electric current flow in cell pairs isolated from adult rat hearts

Cell pairs were isolated from ventricles of adult rat hearts so as to study cell-to-cell coupling. Both cells of each pair were impaled with micro-electrodes connected to balanced bridge circuits. Rectangular current pulses were passed and the resulting voltage deflexions monitored. The data were analysed in terms of a delta configuration of three resistive elements, the resistances of the non-junctional membrane of cell 1 and cell 2 (rm, 1 and rm, 2), and the resistance of the nexal membrane (rn). The nexal membrane resistance was found to be insensitive to voltage gradients across the non-junctional membrane (range examined: -70 to -10 mV) and direction of current flow. The mean value of rn was 2.12 M omega ([K+]o = 12 mM). Taking into account morphological parameters, this corresponds to a specific nexal membrane resistance (Rn) of 0.1 omega cm2. Spontaneous uncoupling in which one cell remained polarized while the other one depolarized was never observed. The current-voltage relationship of the non-junctional membrane was found to be bell-shaped. The specific resistance (Rm) at the resting membrane potential (approximately -50 mV) was 3.2 k omega cm2 ([K+]o = 12 mM). Comparative studies performed on single cells revealed a similar relationship Rm versus Vm. Rm at the resting membrane potential (Vm approximately -50 mV) was 2.5 k omega cm2 ([K+]o = 12 mM). The specific capacitance of the non-junctional membrane (Cm) was determined from experiments on single cells. Cm was found to be independent of Vm (voltage range: -80 to 0 mV). The mean value of Cm was 1.66 microF/cm2 ([K+]o = 12 mM). For comparison, experiments on cell pairs and single cells were also carried out with [K+]o = 4 mM. The values obtained for Rn, Rm and Cm did not deviate significantly from those found with [K+]o = 12 mM.