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Blair GA, Wu X, Bain C, Warren M, Hoeker GS, Poelzing S. Mannitol and hyponatremia regulate cardiac ventricular conduction in the context of sodium channel loss of function. Am J Physiol Heart Circ Physiol 2024; 326:H724-H734. [PMID: 38214908 PMCID: PMC11221810 DOI: 10.1152/ajpheart.00211.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/13/2024]
Abstract
Scn5a heterozygous null (Scn5a+/-) mice have historically been used to investigate arrhythmogenic mechanisms of diseases such as Brugada syndrome (BrS) and Lev's disease. Previously, we demonstrated that reducing ephaptic coupling (EpC) in ex vivo hearts exacerbates pharmacological voltage-gated sodium channel (Nav)1.5 loss of function (LOF). Whether this effect is consistent in a genetic Nav1.5 LOF model is yet to be determined. We hypothesized that loss of EpC would result in greater reduction in conduction velocity (CV) for the Scn5a+/- mouse relative to wild type (WT). In vivo ECGs and ex vivo optical maps were recorded from Langendorff-perfused Scn5a+/- and WT mouse hearts. EpC was reduced with perfusion of a hyponatremic solution, the clinically relevant osmotic agent mannitol, or a combination of the two. Neither in vivo QRS duration nor ex vivo CV during normonatremia was significantly different between the two genotypes. In agreement with our hypothesis, we found that hyponatremia severely slowed CV and disrupted conduction for 4/5 Scn5a+/- mice, but 0/6 WT mice. In addition, treatment with mannitol slowed CV to a greater extent in Scn5a+/- relative to WT hearts. Unexpectedly, treatment with mannitol during hyponatremia did not further slow CV in either genotype, but resolved the disrupted conduction observed in Scn5a+/- hearts. Similar results in guinea pig hearts suggest the effects of mannitol and hyponatremia are not species specific. In conclusion, loss of EpC through either hyponatremia or mannitol alone results in slowed or disrupted conduction in a genetic model of Nav1.5 LOF. However, the combination of these interventions attenuates conduction slowing.NEW & NOTEWORTHY Cardiac sodium channel loss of function (LOF) diseases such as Brugada syndrome (BrS) are often concealed. We optically mapped mouse hearts with reduced sodium channel expression (Scn5a+/-) to evaluate whether reduced ephaptic coupling (EpC) can unmask conduction deficits. Data suggest that conduction deficits in the Scn5a+/- mouse may be unmasked by treatment with hyponatremia and perinexal widening via mannitol. These data support further investigation of hyponatremia and mannitol as novel diagnostics for sodium channel loss of function diseases.
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Affiliation(s)
- Grace A Blair
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, Virginia, United States
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States
| | - Xiaobo Wu
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States
| | - Chandra Bain
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States
| | - Mark Warren
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States
| | - Gregory S Hoeker
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States
| | - Steven Poelzing
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, Virginia, United States
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, United States
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2
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Adams WP, Raisch TB, Zhao Y, Davalos R, Barrett S, King DR, Bain CB, Colucci-Chang K, Blair GA, Hanlon A, Lozano A, Veeraraghavan R, Wan X, Deschenes I, Smyth JW, Hoeker GS, Gourdie RG, Poelzing S. Extracellular Perinexal Separation Is a Principal Determinant of Cardiac Conduction. Circ Res 2023; 133:658-673. [PMID: 37681314 PMCID: PMC10561697 DOI: 10.1161/circresaha.123.322567] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Cardiac conduction is understood to occur through gap junctions. Recent evidence supports ephaptic coupling as another mechanism of electrical communication in the heart. Conduction via gap junctions predicts a direct relationship between conduction velocity (CV) and bulk extracellular resistance. By contrast, ephaptic theory is premised on the existence of a biphasic relationship between CV and the volume of specialized extracellular clefts within intercalated discs such as the perinexus. Our objective was to determine the relationship between ventricular CV and structural changes to micro- and nanoscale extracellular spaces. METHODS Conduction and Cx43 (connexin43) protein expression were quantified from optically mapped guinea pig whole-heart preparations perfused with the osmotic agents albumin, mannitol, dextran 70 kDa, or dextran 2 MDa. Peak sodium current was quantified in isolated guinea pig ventricular myocytes. Extracellular resistance was quantified by impedance spectroscopy. Intercellular communication was assessed in a heterologous expression system with fluorescence recovery after photobleaching. Perinexal width was quantified from transmission electron micrographs. RESULTS CV primarily in the transverse direction of propagation was significantly reduced by mannitol and increased by albumin and both dextrans. The combination of albumin and dextran 70 kDa decreased CV relative to albumin alone. Extracellular resistance was reduced by mannitol, unchanged by albumin, and increased by both dextrans. Cx43 expression and conductance and peak sodium currents were not significantly altered by the osmotic agents. In response to osmotic agents, perinexal width, in order of narrowest to widest, was albumin with dextran 70 kDa; albumin or dextran 2 MDa; dextran 70 kDa or no osmotic agent, and mannitol. When compared in the same order, CV was biphasically related to perinexal width. CONCLUSIONS Cardiac conduction does not correlate with extracellular resistance but is biphasically related to perinexal separation, providing evidence that the relationship between CV and extracellular volume is determined by ephaptic mechanisms under conditions of normal gap junctional coupling.
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Affiliation(s)
- William P. Adams
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
- Translational Biology, Medicine and Health Program at Virginia Tech
| | - Tristan B. Raisch
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
- Translational Biology, Medicine and Health Program at Virginia Tech
| | - Yajun Zhao
- School of Biomedical Engineering and Sciences, Virginia Tech
| | - Rafael Davalos
- School of Biomedical Engineering and Sciences, Virginia Tech
| | | | - D. Ryan King
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
- Translational Biology, Medicine and Health Program at Virginia Tech
| | - Chandra B. Bain
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
| | - Katrina Colucci-Chang
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
- School of Biomedical Engineering and Sciences, Virginia Tech
| | - Grace A. Blair
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
- Translational Biology, Medicine and Health Program at Virginia Tech
| | - Alexandra Hanlon
- Virginia Tech Center for Biostatistics and Health Data Science, Roanoke, Virginia
| | - Alicia Lozano
- Virginia Tech Center for Biostatistics and Health Data Science, Roanoke, Virginia
| | - Rengasayee Veeraraghavan
- Department of Biomedical Engineering, College of Engineering, The Ohio State University
- The Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center
| | - Xiaoping Wan
- The Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center
| | - Isabelle Deschenes
- The Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University Wexner Medical Center
| | - James W. Smyth
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
- Department of Biological Sciences, College of Science, Virginia Tech
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Gregory S. Hoeker
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
| | - Robert G. Gourdie
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
- School of Biomedical Engineering and Sciences, Virginia Tech
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Steven Poelzing
- Center for Vascular and Heart Research at Fralin Biomedical Research Institute at VTC
- Translational Biology, Medicine and Health Program at Virginia Tech
- School of Biomedical Engineering and Sciences, Virginia Tech
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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Wu X, Hoeker GS, Blair GA, King DR, Gourdie RG, Weinberg SH, Poelzing S. Hypernatremia and intercalated disc edema synergistically exacerbate long-QT syndrome type 3 phenotype. Am J Physiol Heart Circ Physiol 2021; 321:H1042-H1055. [PMID: 34623182 DOI: 10.1152/ajpheart.00366.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac voltage-gated sodium channel gain-of-function prolongs repolarization in the long-QT syndrome type 3 (LQT3). Previous studies suggest that narrowing the perinexus within the intercalated disc, leading to rapid sodium depletion, attenuates LQT3-associated action potential duration (APD) prolongation. However, it remains unknown whether extracellular sodium concentration modulates APD prolongation during sodium channel gain-of-function. We hypothesized that elevated extracellular sodium concentration and widened perinexus synergistically prolong APD in LQT3. LQT3 was induced with sea anemone toxin (ATXII) in Langendorff-perfused guinea pig hearts (n = 34). Sodium concentration was increased from 145 to 160 mM. Perinexal expansion was induced with mannitol or the sodium channel β1-subunit adhesion domain antagonist (βadp1). Epicardial ventricular action potentials were optically mapped. Individual and combined effects of varying clefts and sodium concentrations were simulated in a computational model. With ATXII, both mannitol and βadp1 significantly widened the perinexus and prolonged APD, respectively. The elevated sodium concentration alone significantly prolonged APD as well. Importantly, the combination of elevated sodium concentration and perinexal widening synergistically prolonged APD. Computational modeling results were consistent with animal experiments. Concurrently elevating extracellular sodium and increasing intercalated disc edema prolongs repolarization more than the individual interventions alone in LQT3. This synergistic effect suggests an important clinical implication that hypernatremia in the presence of cardiac edema can markedly increase LQT3-associated APD prolongation. Therefore, to our knowledge, this is the first study to provide evidence of a tractable and effective strategy to mitigate LQT3 phenotype by means of managing sodium levels and preventing cardiac edema in patients.NEW & NOTEWORTHY This is the first study to demonstrate that the long-QT syndrome type 3 (LQT3) phenotype can be exacerbated or concealed by regulating extracellular sodium concentrations and/or the intercalated disc separation. The animal experiments and computational modeling in the current study reveal a critically important clinical implication: sodium dysregulation in the presence of edema within the intercalated disc can markedly increase the risk of arrhythmia in LQT3. These findings strongly suggest that maintaining extracellular sodium within normal physiological limits may be an effective and inexpensive therapeutic option for patients with congenital or acquired sodium channel gain-of-function diseases.
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Affiliation(s)
- Xiaobo Wu
- Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Roanoke, Virginia.,Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia
| | - Gregory S Hoeker
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia
| | - Grace A Blair
- Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Roanoke, Virginia.,Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia
| | - D Ryan King
- Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Roanoke, Virginia.,Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia
| | - Robert G Gourdie
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia.,Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Seth H Weinberg
- Department of Biomedical Engineering, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio
| | - Steven Poelzing
- Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Roanoke, Virginia.,Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia.,Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
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King DR, Padget RL, Perry J, Hoeker G, Smyth JW, Brown DA, Poelzing S. Elevated perfusate [Na +] increases contractile dysfunction during ischemia and reperfusion. Sci Rep 2020; 10:17289. [PMID: 33057157 PMCID: PMC7560862 DOI: 10.1038/s41598-020-74069-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
Recent studies revealed that relatively small changes in perfusate sodium ([Na+]o) composition significantly affect cardiac electrical conduction and stability in contraction arrested ex vivo Langendorff heart preparations before and during simulated ischemia. Additionally, [Na+]o modulates cardiomyocyte contractility via a sodium-calcium exchanger (NCX) mediated pathway. It remains unknown, however, whether modest changes to [Na+]o that promote electrophysiologic stability similarly improve mechanical function during baseline and ischemia-reperfusion conditions. The purpose of this study was to quantify cardiac mechanical function during ischemia-reperfusion with perfusates containing 145 or 155 mM Na+ in Langendorff perfused isolated rat heart preparations. Relative to 145 mM Na+, perfusion with 155 mM [Na+]o decreased the amplitude of left-ventricular developed pressure (LVDP) at baseline and accelerated the onset of ischemic contracture. Inhibiting NCX with SEA0400 abolished LVDP depression caused by increasing [Na+]o at baseline and reduced the time to peak ischemic contracture. Ischemia-reperfusion decreased LVDP in all hearts with return of intrinsic activity, and reperfusion with 155 mM [Na+]o further depressed mechanical function. In summary, elevating [Na+]o by as little as 10 mM can significantly modulate mechanical function under baseline conditions, as well as during ischemia and reperfusion. Importantly, clinical use of Normal Saline, which contains 155 mM [Na+]o, with cardiac ischemia may require further investigation.
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Affiliation(s)
- D Ryan King
- Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Rachel L Padget
- Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Justin Perry
- Department of Human Nutrition, Virginia Polytechnic Institute and State University, Foods, and Exercise, Blacksburg, VA, USA
| | - Gregory Hoeker
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
| | - James W Smyth
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - David A Brown
- Department of Human Nutrition, Virginia Polytechnic Institute and State University, Foods, and Exercise, Blacksburg, VA, USA
| | - Steven Poelzing
- Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA. .,Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA. .,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. .,Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
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5
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Hoeker GS, James CC, Tegge AN, Gourdie RG, Smyth JW, Poelzing S. Attenuating loss of cardiac conduction during no-flow ischemia through changes in perfusate sodium and calcium. Am J Physiol Heart Circ Physiol 2020; 319:H396-H409. [PMID: 32678707 DOI: 10.1152/ajpheart.00112.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Myocardial ischemia leads to conduction slowing, cell-to-cell uncoupling, and arrhythmias. We previously demonstrated that varying perfusate sodium (Na+) and calcium (Ca2+) attenuates conduction slowing and arrhythmias during simulated ischemia with continuous perfusion. Cardioprotection was selectively associated with widening of the perinexus, a gap junction adjacent nanodomain important to ephaptic coupling. It is unknown whether perfusate composition affects the perinexus or ischemic conduction during nonsimulated ischemia, when coronary flow is reduced or halted. We hypothesized that altering preischemic perfusate composition could facilitate perinexal expansion and attenuate conduction slowing during global ischemia. To test this hypothesis, ex vivo guinea pig hearts (n = 49) were Langendorff perfused with 145 or 153 mM Na+ and 1.25 or 2.0 mM Ca2+ and optically mapped during 30 min of no-flow ischemia. Altering Na+ and Ca2+ did not substantially affect baseline conduction. Increasing Na+ and decreasing Ca2+ both lowered pacing thresholds, whereas increasing Ca2+ narrowed perinexal width (Wp). A least squares mean estimate revealed that reduced perfusate Na+ and Ca2+ resulted in the most severe conduction slowing during ischemia. Increasing Na+ alone modestly attenuated conduction slowing, yet significantly delayed the median time to conduction block (10 to 16 min). Increasing both Na+ and Ca2+ selectively widened Wp during ischemia (22.7 vs. 15.7 nm) and attenuated conduction slowing to the greatest extent. Neither repolarization nor levels of total or phosphorylated connexin43 correlated with conduction slowing or block. Thus, perfusate-dependent widening of the perinexus preserved ischemic conduction and may be an adaptive response to ischemic stress.NEW & NOTEWORTHY Conduction slowing during acute ischemia creates an arrhythmogenic substrate. We have shown that extracellular ionic concentrations can alter conduction by modulating ephaptic coupling. Here, we demonstrate increased extracellular sodium and calcium significantly attenuate conduction slowing during no-flow ischemia. This effect was associated with selective widening of the perinexus, an intercalated disc nanodomain and putative cardiac ephapse. These findings suggest that acute changes in ephaptic coupling may serve as an adaptive response to ischemic stress.
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Affiliation(s)
- Gregory S Hoeker
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia
| | - Carissa C James
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia.,Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Allison N Tegge
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Robert G Gourdie
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia.,Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - James W Smyth
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia.,Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Steven Poelzing
- Center for Heart and Reparative Medicine Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia.,Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University, Roanoke, Virginia.,Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
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6
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George SA, Hoeker G, Calhoun PJ, Entz M, Raisch TB, King DR, Khan M, Baker C, Gourdie RG, Smyth JW, Nielsen MS, Poelzing S. Modulating cardiac conduction during metabolic ischemia with perfusate sodium and calcium in guinea pig hearts. Am J Physiol Heart Circ Physiol 2019; 316:H849-H861. [PMID: 30707595 DOI: 10.1152/ajpheart.00083.2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We previously demonstrated that altering extracellular sodium (Nao) and calcium (Cao) can modulate a form of electrical communication between cardiomyocytes termed "ephaptic coupling" (EpC), especially during loss of gap junction coupling. We hypothesized that altering Nao and Cao modulates conduction velocity (CV) and arrhythmic burden during ischemia. Electrophysiology was quantified by optically mapping Langendorff-perfused guinea pig ventricles with modified Nao (147 or 155 mM) and Cao (1.25 or 2.0 mM) during 30 min of simulated metabolic ischemia (pH 6.5, anoxia, aglycemia). Gap junction-adjacent perinexal width ( WP), a candidate cardiac ephapse, and connexin (Cx)43 protein expression and Cx43 phosphorylation at S368 were quantified by transmission electron microscopy and Western immunoblot analysis, respectively. Metabolic ischemia slowed CV in hearts perfused with 147 mM Nao and 2.0 mM Cao; however, theoretically increasing EpC with 155 mM Nao was arrhythmogenic, and CV could not be measured. Reducing Cao to 1.25 mM expanded WP, as expected during ischemia, consistent with reduced EpC, but attenuated CV slowing while delaying arrhythmia onset. These results were further supported by osmotically reducing WP with albumin, which exacerbated CV slowing and increased early arrhythmias during ischemia, whereas mannitol expanded WP, permitted conduction, and delayed the onset of arrhythmias. Cx43 expression patterns during the various interventions insufficiently correlated with observed CV changes and arrhythmic burden. In conclusion, decreasing perfusate calcium during metabolic ischemia enhances perinexal expansion, attenuates conduction slowing, and delays arrhythmias. Thus, perinexal expansion may be cardioprotective during metabolic ischemia. NEW & NOTEWORTHY This study demonstrates, for the first time, that modulating perfusate ion composition can alter cardiac electrophysiology during simulated metabolic ischemia.
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Affiliation(s)
- Sharon A George
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University , Blacksburg, Virginia.,Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia
| | - Gregory Hoeker
- Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia
| | - Patrick J Calhoun
- Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia.,Department of Biological Sciences, Virginia Polytechnic Institute and State University , Blacksburg, Virginia
| | - Michael Entz
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University , Blacksburg, Virginia.,Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia
| | - Tristan B Raisch
- Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia.,Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University , Blacksburg, Virginia
| | - D Ryan King
- Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia.,Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University , Blacksburg, Virginia
| | - Momina Khan
- Department of Human Food Nutrition and Exercise, Virginia Polytechnic Institute and State University , Blacksburg, Virginia
| | - Chandra Baker
- Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia
| | - Robert G Gourdie
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University , Blacksburg, Virginia.,Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia
| | - James W Smyth
- Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia.,Department of Biological Sciences, Virginia Polytechnic Institute and State University , Blacksburg, Virginia
| | - Morten S Nielsen
- Department of Biomedical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Steven Poelzing
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University , Blacksburg, Virginia.,Center for Heart and Reparative Medicine Research, Virginia Tech Carilion Research Institute , Roanoke, Virginia.,Translational Biology, Medicine, and Health Graduate Program, Virginia Polytechnic Institute and State University , Blacksburg, Virginia
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