Depressed transmembrane potentials during experimentally induced ventricular failure in cats

Current Perspectives of Electrical Remodeling and Its Therapeutic Implications

Electrical remodeling involves alterations in the electrophysiologic milieu of myocardium in various disease states, such as ventricular hypertrophy, heart failure, atrial tachyarrhythmias, myocardial ischemia, and infarction that are associated with cardiac arrhythmias. Although research in this area dates back to early part of the 19th century, we still lack the exact knowledge of ionic remodeling, the role of various genes and channel proteins, and their relevance for the newer antiarrhythmic therapies. Structural remodeling may also have an impact on the electrical remodeling process, although differences in both structural and electrical remodeling are associated with different disease states. Various electrophysiologic, cellular, and structural alterations, including anisotropic conduction, increased intracellular calcium levels, and gap junction remodeling predispose to increased dispersion of action potential duration and refractoriness. This constitutes a favorable substrate for early and late afterdepolarizations and reentrant arrhythmias. Studying the role of ionic remodeling in the initiation and propagation of cardiac arrhythmias has significant relevance for developing newer antiarrhythmic therapies, for identifying patients at risk of developing fatal arrhythmias, and for implementing effective preventive measures. Further research is required to understand the specific effects of individual ion channel remodeling, to understand the signal transduction mechanisms, and to address whether detrimental effects of electrical remodeling can be altered.

Conduction abnormalities and ventricular arrhythmogenesis: The roles of sodium channels and gap junctions

Ventricular arrhythmias arise from disruptions in the normal orderly sequence of electrical activation and recovery of the heart. They can be categorized into disorders affecting predominantly cellular depolarization or repolarization, or those involving action potential (AP) conduction. This article briefly discusses the factors causing conduction abnormalities in the form of unidirectional conduction block and reduced conduction velocity (CV). It then examines the roles that sodium channels and gap junctions play in AP conduction. Finally, it synthesizes experimental results to illustrate molecular mechanisms of how abnormalities in these proteins contribute to such conduction abnormalities and hence ventricular arrhythmogenesis, in acquired pathologies such as acute ischaemia and heart failure, as well as inherited arrhythmic syndromes.

Determinants of myocardial conduction velocity: implications for arrhythmogenesis

Slowed myocardial conduction velocity (θ) is associated with an increased risk of re-entrant excitation, predisposing to cardiac arrhythmia. θ is determined by the ion channel and physical properties of cardiac myocytes and by their interconnections. Thus, θ is closely related to the maximum rate of action potential (AP) depolarization [(dV/dt)_max], as determined by the fast Na⁺ current (I_Na); the axial resistance (r_a) to local circuit current flow between cells; their membrane capacitances (c_m); and to the geometrical relationship between successive myocytes within cardiac tissue. These determinants are altered by a wide range of pathophysiological conditions. Firstly, I_Na is reduced by the impaired Na⁺ channel function that arises clinically during heart failure, ischemia, tachycardia, and following treatment with class I antiarrhythmic drugs. Such reductions also arise as a consequence of mutations in SCN5A such as those occurring in Lenègre disease, Brugada syndrome (BrS), sick sinus syndrome, and atrial fibrillation (AF). Secondly, r_a, may be increased due to gap junction decoupling following ischemia, ventricular hypertrophy, and heart failure, or as a result of mutations in CJA5 found in idiopathic AF and atrial standstill. Finally, either r_a or c_m could potentially be altered by fibrotic change through the resultant decoupling of myocyte–myocyte connections and coupling of myocytes with fibroblasts. Such changes are observed in myocardial infarction and cardiomyopathy or following mutations in MHC403 and SCN5A resulting in hypertrophic cardiomyopathy (HCM) or Lenègre disease, respectively. This review defines and quantifies the determinants of θ and summarizes experimental evidence that links changes in these determinants with reduced myocardial θ and arrhythmogenesis. It thereby identifies the diverse pathophysiological conditions in which abnormal θ may contribute to arrhythmia.

Arrhythmogenic Ion-Channel Remodeling in the Heart: Heart Failure, Myocardial Infarction, and Atrial Fibrillation

Rhythmic and effective cardiac contraction depends on appropriately timed generation and spread of cardiac electrical activity. The basic cellular unit of such activity is the action potential, which is shaped by specialized proteins (channels and transporters) that control the movement of ions across cardiac cell membranes in a highly regulated fashion. Cardiac disease modifies the operation of ion channels and transporters in a way that promotes the occurrence of cardiac rhythm disturbances, a process called “arrhythmogenic remodeling.” Arrhythmogenic remodeling involves alterations in ion channel and transporter expression, regulation and association with important protein partners, and has important pathophysiological implications that contribute in major ways to cardiac morbidity and mortality. We review the changes in ion channel and transporter properties associated with three important clinical and experimental paradigms: congestive heart failure, myocardial infarction, and atrial fibrillation. We pay particular attention to K+, Na+, and Ca2+channels; Ca2+transporters; connexins; and hyperpolarization-activated nonselective cation channels and discuss the mechanisms through which changes in ion handling processes lead to cardiac arrhythmias. We highlight areas of future investigation, as well as important opportunities for improved therapeutic approaches that are being opened by an improved understanding of the mechanisms of arrhythmogenic remodeling.

Electrical and structural remodeling of the failing ventricle

Heart failure (HF) is a complex disease that presents a major public health challenge to Western society. The prevalence of HF increases with age in the elderly population, and the societal disease burden will increase with prolongation of life expectancy. HF is initially characterized by an adaptive increase of neurohumoral activation to compensate for reduction of cardiac output. This leads to a combination of neurohumoral activation and mechanical stress in the failing heart that trigger a cascade of maladaptive electrical and structural events that impair both the systolic and diastolic function of the heart.

Effects of intracellular calcium elevation on action potential and L-type calcium current of normal and chronically infarcted rat ventricles

The present work investigated the effects of raising [Ca+2]i levels on action potential (AP) and L-type calcium current (I(Ca.L)) of normal and chronically infarcted rat ventricles. Experiments were performed by conventional electrophysiology and whole-cell patch-clamp techniques. In the former, APs were recorded in ventricular strips subjected to different pacing rates or elevation of [Ca+2]o levels. In the latter, I(Ca.L) was studied in isolated myocytes in the absence of an intracellular Ca+2 chelator. The acceleration of heart rate (6 to 240 beats/min) reduced AP duration measured at 20%, 50%, and 90% repolarization (APD20, APD50, and APD90) in the infarcted group, and increased APD20 and APD50 in the control group. Rising [Ca+]o (1.25 to 5.0 mmol/L) induced a decrease of APD20 and APD50 in both groups. Voltage clamp revealed a smaller I(Ca.L) density at approximately -17 mV in myocytes from infarcted ventricles (-1.86 +/- 0.37 vs -3.98 +/- 0.65 pA/pF, P < .05), and the appearance of a non-K+ outward current coupled to I(Ca.L). The results suggest the participation of a Ca+2-activated outward current in the repolarization of normal and infarcted rat ventricles.

Molecular mechanisms of myocardial remodeling

"Remodeling" implies changes that result in rearrangement of normally existing structures. This review focuses only on permanent modifications in relation to clinical dysfunction in cardiac remodeling (CR) secondary to myocardial infarction (MI) and/or arterial hypertension and includes a special section on the senescent heart, since CR is mainly a disease of the elderly. From a biological point of view, CR is determined by 1 ) the general process of adaptation which allows both the myocyte and the collagen network to adapt to new working conditions; 2) ventricular fibrosis, i.e., increased collagen concentration, which is multifactorial and caused by senescence, ischemia, various hormones, and/or inflammatory processes; 3) cell death, a parameter linked to fibrosis, which is usually due to necrosis and apoptosis and occurs in nearly all models of CR. The process of adaptation is associated with various changes in genetic expression, including a general activation that causes hypertrophy, isogenic shifts which result in the appearance of a slow isomyosin, and a new Na+-K+-ATPase with a low affinity for sodium, reactivation of genes encoding for atrial natriuretic factor and the renin-angiotensin system, and a diminished concentration of sarcoplasmic reticulum Ca2+-ATPase, beta-adrenergic receptors, and the potassium channel responsible for transient outward current. From a clinical point of view, fibrosis is for the moment a major marker for cardiac failure and a crucial determinant of myocardial heterogeneity, increasing diastolic stiffness, and the propensity for reentry arrhythmias. In addition, systolic dysfunction is facilitated by slowing of the calcium transient and the downregulation of the entire adrenergic system. Modifications of intracellular calcium movements are the main determinants of the triggered activity and automaticity that cause arrhythmias and alterations in relaxation.

The sympathetic nervous system in chronic heart failure

The sympathetic nervous system plays a pivotal role in the natural history of chronic heart failure (CHF). There is early activation of cardiac adrenergic drive, which is followed by an increasing magnitude of generalized sympathetic activation, with worsening heart failure. The adverse consequences predominate over the short-term compensatory effects and are mediated through downregulation of beta-receptor function and harmful biological effects on the cardiomyocyte. beta-blockers exert a beneficial effect on the natural history of CHF by attenuating the negative biological effects, restoring homogeneity of contractile/relaxant mechanisms, and reducing the risk of myocardial ischemia and arrhythmias. After pioneering work conducted over 20 years ago, numerous studies have shown the beneficial effects of beta-blockade on left ventricular function, and survival, morbidity, and mortality rates in CHF. Large-scale trials are underway to determine the overall benefits of beta-blockade in heart failure.

Mechanisms of arrhythmias in heart failure

The diagnosis of heart failure infers a bad prognosis. Mortality is high and many patients die suddenly. Ventricular arrhythmias, commonly observed in patients with heart failure, are thought to underlie at least some of these sudden deaths. The mechanism of arrhythmias occurring in the setting of heart failure is still unclear. Experimental evidence points to a higher tendency for failing myocardium to develop delayed and early afterdepolarization-induced triggered activity and automaticity. Conditions favoring reentry also have been described in failing hearts. Modulating factors such as sympathetic activation, electrolyte disturbances, and chronic stretch are present in the setting of heart failure and may favor all of the mentioned mechanisms of arrhythmias. Clinical evaluation of arrhythmias in patients and animals with heart failure and the effects of pharmacologic treatment of ventricular arrhythmias in patients with depressed left ventricular function further accentuate that more than one mechanism of arrhythmia may be operating in heart failure and underscore the importance of modulating factors such as sympathetic activation and stretch.

Ventricular action potential and L-type calcium channel in infarct-induced hypertrophy in rats

INTRODUCTION

The present investigation was aimed at characterization of: (1) action potential parameters; and (2) L-type calcium channels in the hypertrophied ventricular tissue surviving an extensive healed myocardial infarction in the rat.

METHODS AND RESULTS

Myocardial infarction was produced in Wistar rats by ligation of the left coronary artery. One to 2 months later, their hearts were subjected to electrophysiologic study. The main difference in subendocardial transmembrane potentials recorded with intracellular microelectrodes was an increase in action potential duration (APD). In the left ventricle, the infarcted/sham-operated APD ratio ranged from 2.7 to 7.2, whereas in the right ventricle it ranged from 1.6 to 2.3 in different regions. When compared with control cells, ventricular myocytes from infarcted hearts were found to be larger (P < 0.01) and showed a reduction (P < 0.05) in L-type calcium current (LCa,L) density obtained by whole cell, patch clamp (at 0 mV: 4.44 +/- 0.41 in infarcted vs 8.03 +/- 1.22 pA/pF in normal). The time course of decay of the currents could be fitted by two exponential functions in both normal and infarcted hearts. There was a tendency toward an increase in the time constant of the slower component of inactivation, tau 2, significant only at +20 mV (215 +/- 25 vs 151 +/- 15 msec).

CONCLUSIONS

Cardiac hypertrophy of healed infarction in rats is associated with lengthening of the action potential in both ventricles. The main alteration observed in ICa,L was a decrease in the current density. Thus, alteration of the calcium channel is not the determinant factor of APD increase.

Transmural heterogeneity of norepinephrine uptake in failing human hearts

OBJECTIVES

The aim of this study was to determine whether regional heterogeneity in myocardial sympathetic neural function measured by the uptake of norepinephrine could account for the spatial heterogeneity of beta-adrenergic receptor down-regulation that occurs in the failing human heart.

BACKGROUND

Myocardial beta-adrenergic receptor density and function are diminished in patients with chronic heart failure. Down-regulation occurs predominantly in the subendocardium, suggesting that local rather than systemic alterations in sympathetic neural function may be responsible. Although some studies have implicated hypofunction of cardiac sympathetic nerves with defective norepinephrine uptake, others suggest increased cardiac sympathetic nerve activity with unimpaired uptake.

METHODS

We measured norepinephrine uptake by incubating transmural slices of the left ventricle from 19 patients who had chronic heart failure and three nonfailing control hearts with [3H]norepinephrine with or without desipramine, a neuronal uptake blocker. The density of uptake sites was measured in subepicardial and subendocardial myocyte regions with light microscopic autoradiography.

RESULTS

Although the amount of [3H]norepinephrine uptake varied considerably in failing ventricles, uptake was directly proportional (r = 0.46, p < 0.05) to beta 1-adrenergic receptor density measured in additional slices with radioligand binding assays. In addition, marked transmural heterogeneity in [3H] norepinephrine uptake was consistently observed in failing ventricles. Uptake in subendocardial myocyte regions was significantly less than in subepicardial regions (mean [ +/- SD] subepicardial/subendocardial uptake ratio 4.7 +/- 4.8, p < 0.01). The extent of transmural heterogeneity in norepinephrine uptake was similar in patients with idiopathic and ischemic cardiomyopathy. In contrast, nonfailing hearts exhibited more uniform transmural [3H]norepinephrine uptake (subepicardial/subendocardial uptake ratio 1.8 +/- 1.2, p = NS).

CONCLUSIONS

Specific [3H]norepinephrine accumulation is approximately fivefold lower in subendocardial regions of failing left ventricles than in subepicardial regions. These findings support the hypothesis that a subendocardial defect in norepinephrine uptake may chronically elevate local interstitial catecholamine levels and thereby down-regulate beta-adrenergic receptors in a spatially heterogeneous distribution.

Changes in action potential kinetics following experimental bladder outflow obstruction in the guinea pig

The effect of experimental bladder outflow obstruction on membrane electrical activity of guinea pig detrusor smooth muscle was studied. Using an intracellular microelectrode technique, action potentials were recorded from single smooth muscle cells to determine the effect of outflow obstruction on action potential (AP) kinetics. Bladder outflow obstruction resulted in smooth muscle hypertrophy with bladder weight gain to 2.7 times control levels after 8-12 weeks' obstruction. The changes in the AP kinetics noted with obstruction-induced bladder hypertrophy were a prolongation of the AP duration and a decrease in the maximum velocity of depolarization and repolarization. The AP amplitude, after hyperpolarization and overshoot potential in addition to the resting membrane potential (RMP) did not change significantly with bladder outflow obstruction. The values of these AP parameters were not affected significantly by the application of atropine and guanethidine in smooth muscle tissue from either control or obstructed bladders. These results suggest that the active electrical properties of the detrusor smooth muscle membrane are changed significantly by obstruction-induced bladder hypertrophy. Furthermore, the results suggest that adrenergic and cholinergic neurotransmitters do not contribute to these changes in AP kinetics following obstruction. The changes in AP properties with outflow obstruction-induced bladder hypertrophy were compared with those previously reported for the hypertrophic myocardium and were discussed in relation to the known impaired contractile properties of obstructed bladder smooth muscle.

Sudden death in idiopathic dilated cardiomyopathy

Approximately 30% of deaths among patients with IDCM are sudden. Although ventricular tachyarrhythmias are responsible for many of these deaths, bradyarrhythmias may also play a significant role. Patients with a previous history of sustained ventricular arrhythmias are at high risk for sudden death. In patients without prior symptomatic ventricular arrhythmias a history of unexplained syncope, severely impaired right ventricular hemodynamics, frequent spontaneous ventricular ectopy or NSVT, and inducible SMVT may help identify those at greatest risk of dying suddenly. With the exception of angiotensin-converting enzyme inhibitor therapy, attempts at pharmacologic prevention of sudden death have had limited efficacy. The implantable defibrillator offers promising results in survivors of previous sustained ventricular arrhythmias; its prophylactic use in other high-risk subgroups is the subject of active investigation.

Analysis of the detrusor smooth muscle action potential

A method is described to record bladder smooth muscle action potential (AP) data and subsequently in digitized form analyze the constitutive elements of the AP. Manipulation of digitized data can give accurate descriptive information on the AP configuration and kinetics. In the future this type of analysis will hopefully lead to more precise, quantitative information on changes in the smooth muscle AP kinetics with disease states and facilitate a clearer understanding of the pathophysiological processes underlying changes in detrusor contractility.

Is the adaptation of right ventricular refractoriness to an abrupt increase in heart rate impaired in chronic heart failure?

Chronic heart failure is associated with a high risk of ventricular arrhythmias and sudden death, although the mechanisms leading to these arrhythmias are not fully understood. To determine if the adaptation of ventricular refractoriness to an abrupt increase in heart rate is impaired in heart failure, electrophysiologic findings in 11 patients with structurally normal hearts (group I) were compared to findings in 28 patients with chronic heart failure (mean left ventricular ejection fraction 0.23 +/- 0.05). Heart failure was due to coronary artery disease in 14 patients (group II) and to idiopathic dilated cardiomyopathy in 14 patients (group III). The effective refractory period at the right ventricular apex was measured during unipolar cathodal pacing at twice diastolic threshold following a 12-beat ventricular drive at a cycle length of 600 msec. The pacing cycle length was then decreased to 400 msec for one, two, and three beats and the refractory period was determined for each beat at the faster rate. For each beat the mean refractory periods of group II and III patients were similar and were significantly longer than those of group I patients (p less than 0.01). The refractory period progressively shortened at the 400 msec cycle length and the percent decrease for each beat was similar among all three groups (p greater than 0.10). In the group II and III patients there was no correlation of the refractory period or change in refractory period with the pulmonary artery, right atrial, and pulmonary capillary wedge pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraction-excitation feedback in the atria: a cause of changes in refractoriness

The purpose of this study was to investigate the immediate effects of an increase in atrial pressure on atrial refractoriness by determining the relation between the atrial pressure and effective refractory period of the atrium. In 21 open chest anesthetized dogs, after the blocking of atrioventricular (AV) conduction by formalin injection, the left atrium and left ventricle were paced sequentially at a fixed cycle length of 300 ms. The AV interval was varied from 0 to 280 ms in 20 ms steps during the recording of aortic and left atrial pressures and refractory period of the left atrium. Mean left atrial pressure was lowest (8.0 +/- 0.4 mm Hg, all values mean +/- SEM) at an AV interval of 47 +/- 3 ms, when refractory period was 135.5 +/- 2.6 ms. Mean left atrial pressure was highest (13.3 +/- 0.5 mm Hg) at an AV interval of 147 +/- 5 ms, when refractory period was 137.9 +/- 2.4 ms (p less than 0.01). Left atrial diameter measured by echocardiography increased from 33.7 +/- 1.8 mm at an AV interval of 47 ms to 37.8 +/- 1.8 mm (p less than 0.01, n = 10) at an AV interval of 147 ms, and mean aortic pressure decreased from 109 +/- 4 to 101 +/- 4 mm Hg. After surgical decentralization of vagal and sympathetic innervation to eliminate baroreflex influence on refractoriness, left atrial refractory period prolonged from 141.6 +/- 3.4 to 145.4 +/- 3.4 ms (p less than 0.01) when mean left atrial pressure increased from 9.5 +/- 0.4 to 15.2 +/- 0.6 mm Hg. A similar relation was noted between right atrial pressure and right atrial refractory period (n = 10) and between left atrial pressure and refractory period of the interatrial septum (n = 12). In six chronically instrumented conscious dogs, left atrial refractory period prolonged from 116.3 +/- 2.3 to 124.2 +/- 1.7 ms (p less than 0.01) when mean left atrial pressure increased from 4.0 +/- 0.8 to 9.0 +/- 0.3 mm Hg. Therefore, an increase in atrial pressure lengthens refractory period of both atria and the interatrial septum in anesthetized and conscious dogs.

High prevalence of nonsustained ventricular tachycardia in severe congestive heart failure

The prevalence of ventricular arrhythmias was evaluated in 35 patients with severe congestive heart failure (CHF) in New York Heart Association functional class III to IV. The etiology of CHF was equally distributed between ischemic and nonischemic cardiomyopathy. The severity of cardiac dysfunction was evidenced by left ventricular ejection fraction of less than 20%, mean cardiac index of 1.75 +/- 0.40 L/min/m2, pulmonary capillary wedge pressure of 28.1 +/- 7.1 mm Hg, and mean exercise capacity of 6.0 +/- 3.6 minutes. During 24-hour ambulatory Holter monitoring, 71% of these patients demonstrated repetitive episodes of ventricular tachycardia (VT), 92% had multifocal ventricular ectopic beats, and 88% had greater than or equal to 10 ventricular ectopy/1000 normal heart beats. Within 1 to 72 weeks of the Holter monitoring 25 patients died. Death could be attributed to VT in only one patient. In all the others, death was secondary to worsening CHF. Thus, although asymptomatic malignant ventricular arrhythmia occurred frequently in our patients, sudden death was rarely observed.

Abnormalities in the coronary circulation that occur as a consequence of cardiac hypertrophy

Myocardial ischemia is frequently observed in patients with cardiac hypertrophy even when the conduit coronary arteries are normal. Recent studies indicate that impaired coronary reserve in hypertrophied hearts probably occurs because growth of the coronary bed does not keep pace with increases in cardiac mass. The imbalance between vascular proliferation and muscle growth is probably most severe when cardiac hypertrophy is produced by pressure overload. Experimental studies also suggest that abnormalities intrinsic to pressure-hypertrophied heart muscle (decreased capillary density; decreased coronary reserve; electrophysiologic abnormalities) adversely affect the response of the enlarged heart to sudden coronary occlusion. When animals with hypertension and left ventricular hypertrophy are subjected to sudden coronary occlusion, the incidence of sudden cardiac death is increased severalfold and infarct size is substantially augmented. These observations suggest that abnormalities in the coronary microcirculation that accompany cardiac hypertrophy play a significant role in the pathogenesis of the complications associated with cardiac hypertrophy.

Non-uniform electrophysiological properties and electrotonic interaction in hypertrophied rat myocardium

We studied the distribution and nature of the electrical changes associated with myocardial hypertrophy induced by renal hypertension in rats. Standard microelectrode techniques were used to study transmembrane action potentials recorded from endocardial, papillary muscle, and epicardial stimulation from hypertrophied (HBP) and normal (SHAM) hearts. We also determined the effects of stimulation frequency on the action potentials recorded from these preparations. To assess whether altered intercellular electrical connections contribute to the electrophysiological changes associated with hypertrophy, we analyzed the spatial steady state voltage decrement produced by passing intracellular constant current pulses and determined the effective input resistance (Rin) of endocardial HBP and SHAM preparations. Our results show that the action potential prolongation that accompanies hypertrophy is not uniform. Thus, the entire course of repolarization is prolonged in epicardial and papillary muscle fibers, but only the latter half of repolarization is prolonged in epicardial fibers. Endocardial action potentials is general, and HBP action potentials in particular, have a distinctive steep relation between duration and stimulation frequency which may be due to a difference in the rate dependence of a membrane conductance(s), although relatively greater accumulation of extracellular potassium or altered activity of the Na+-K+ pump cannot be excluded as contributing factors. In addition, the similarity in the profile of spatial voltage decrement and the values for Rin in HBP and SHAM preparations indicates that alterations in electrotonic coupling between cells are unlikely to account for the prolonged action potentials of hypertrophied myocardium.

Cardiac beta-adrenoceptors during normal growth of male and female rats

1 A binding assay involving (-)-[3H]dihydroalprenolol (DHA) and KCl-washed cardiac membranes were used to assess the numbers and affinities of beta-adrenoceptors in hearts from male and female rats varying in age from about 2 weeks to 18 months. 2 Although female rats grow more slowly and attain lower adult weights than male rats, heart weights increased in approximate proportion to body weight with little sex difference. 3 As heart weight increased about three fold, beta-receptors increased three fold. Since the number of myocardial cells is believed to be nearly constant during postnatal growth, the numbers of receptors/cell presumably increases similarly. 4 As heart weight increased, the number of beta-receptors per g of tissue decreased according to the equation: total pmol/g = 4.33 - 1.43 x heart weight, equally in males and females. 5 Dissociation constants for DHA (2 to 4 nM) remained the same, and equal, in male and female rats during their growth. 6 An excellent correlation was found between the decline in beta-receptors/g tissue during growth and the decline in the area of the external sarcolemma/g tissue. The data suggest that the number of receptors per unit area remains constant during growth, and thus that cell surface area is a major factor determining normal numbers of receptors per cardiocyte.

Restorative effect of epinephrine on the electrophysiologic properties of depressed human atrial tissue

The effects of epinephrine on the electrophysiologic properties of human right atrail tissue, obtained at cardiac surgery, were evaluated utilizing standard microelectrode techniques. In studies of electrophysiology, epinephrine had little effect on the resting membrane potential and transmembrane action potentials of normal atrial fibers. Epinephrine enhanced phase-4 depolarization and increased automaticity in normal fibers but hyperpolarized partially depolarized atrial fibers and decreased automaticity. The hyperpolarizing action of epinephrine resulted in an increase in action potential amplitude and dV/dt and enhanced conduction. Active force increased 40-230% in depressed tissues when exposed to epinephrine. Epinephrine-induced hyperpolarization of depressed atrail fibers may have a beneficial effect on atrial arrhythmias and depressed contractility encountered clinically.