Electrophysiological effects of ethanol, acetaldehyde, and acetate on cardiac tissues from dog and guinea pig

Mechanisms of cardiac ethanol toxicity and novel treatment options

Ethanol can acutely and chronically alter cardiomyocyte and whole-organ function in the heart. Importantly, ethanol acutely and chronically predisposes to arrhythmias, while chronic abuse can induce heart failure. However, the molecular mechanisms of ethanol toxicity in the heart are incompletely understood. In this review, we summarize the current mechanistic knowledge on cardiac ethanol toxicity, with a focus on druggable pathways. Ethanol effects on excitation-contraction coupling, oxidative stress, apoptosis, and cardiac metabolism, as well as effects of ethanol metabolites will be discussed. Important recent findings have been gained by investigation of acute ethanol effects. These include a renewed focus on reactive oxygen species (ROS) and induction of SR Ca²⁺ leak by CaMKII-mediated pathways downstream of ROS. Furthermore, a clinical outlook into potential novel treatment options is provided.

Addictive drugs, arrhythmias, and cardiac inward rectifiers

In many addictive drugs including alcohol and nicotine, proarrhythmic effects were reported. This review provides an overview of the current knowledge in this field (with a focus on the inward rectifier potassium currents) to promote the lacking data and appeal for their completion, thus, to improve understanding of the proarrhythmic potential of addictive drugs.

[Alcohol and arrhythmias]

The effects of alcohol on induction of arrhythmias is dose-dependent, independent of preexisting cardiovascular diseases or heart failure and can affect otherwise healthy subjects. While the probability of atrial fibrillation increases with the alcohol dosage, events of sudden cardiac death are less frequent with low and moderate consumption but occur more often in heavy drinkers with alcoholic cardiomyopathy. Men are first affected at higher dosages of alcohol but women can suffer from arrhythmias at lower dosages. Thromboembolisms and ischemic stroke can occur less often at lower dosages of alcohol; however, hemorrhagic stroke and subarachnoid hemorrhage are increased with higher alcohol dosages. Recognizable protective mechanisms of alcohol with respect to cardiovascular diseases only occur with lower amounts of alcohol of less than 10 g per day. Underlying mechanisms explain these controversial effects. Specific therapeutic options for alcohol-related arrhythmias apart from abstinence from alcohol consumption are not known.

Acetaldehyde at Clinically Relevant Concentrations Inhibits Inward Rectifier Potassium Current IK1 in Rat Ventricular Myocytes

Considering the effects of alcohol on cardiac electrical behavior as well as the important role of the inward rectifier potassium current IK1 in arrhythmogenesis, this study was aimed at the effect of acetaldehyde, the primary metabolite of ethanol, on IK1 in rat ventricular myocytes. Acetaldehyde induced a reversible inhibition of IK1 with IC50 = 53.7±7.7 µM at –110 mV; a significant inhibition was documented even at clinically-relevant concentrations (at 3 µM by 13.1±3.0 %). The inhibition was voltage-independent at physiological voltages above –90 mV. The IK1 changes under acetaldehyde may contribute to alcohol-induced alterations of cardiac electrophysiology, especially in individuals with a genetic defect of aldehyde dehydrogenase where the acetaldehyde level may be elevated.

Acute effects of ethanol on action potential and intracellular Ca(2+) transient in cardiac ventricular cells: a simulation study

Alcohol consumption may result in electrocardiographic changes and arrhythmias, at least partly due to effects of ethanol on cardiac ionic currents. Contractility and intracellular Ca(2+) dynamics seem to be altered as well. In this study, we integrated the available (mostly animal) experimental data into previously published models of the rat and human ventricular myocytes to assess the share of ionic current components in ethanol-induced changes in AP configuration and cytosolic Ca(2+) transient in ventricular cardiomyocytes. The rat model reproduced well the experimentally observed changes in AP duration (APD) under ethanol (slight prolongation at 0.8 mM and shortening at ≥8 mM). These changes were almost exclusively caused by the ethanol-induced alterations of I K1. The cytosolic Ca(2+) transient decreased gradually with the increasing ethanol concentration as a result of the ethanol-induced inhibition of I Ca. In the human model, ethanol produced a dose-dependent APD lengthening, dominated by ethanol effect on I Kr, the key repolarising current in human ventricles. This effect might contribute to the clinically observed proarrhythmic effects of ethanol in predisposed individuals.

Alcohol and vagal tone as triggers for paroxysmal atrial fibrillation

Alcohol and vagal activity may be important triggers for paroxysmal atrial fibrillation (PAF), but it remains unknown if these associations occur more often than would be expected by chance alone because of the lack of a comparator group in previous studies. We compared self-reported frequency of these triggers in patients with PAF to those with other supraventricular tachycardias (SVTs). Consecutive consenting patients presenting for electrophysiology procedures at a single university medical center underwent a structured interview regarding arrhythmia triggers. Two hundred twenty-three patients with a documented arrhythmia (133 with PAF and 90 with SVT) completed the survey. After multivariable adjustment, patients with PAF had a 4.42 greater odds (95% confidence interval [CI] 1.35 to 14.44) of reporting alcohol consumption (p = 0.014) and a 2.02 greater odds (95% CI 1.02 to 4.00) of reporting vagal activity (p = 0.044) as an arrhythmia trigger compared to patients with SVT. In patients with PAF, drinking primarily beer was associated with alcohol as a trigger (odds ratio [OR] 4.49, 95% CI 1.41 to 14.28, p = 0.011), whereas younger age (OR 0.68, 95% CI 0.49 to 0.95, p = 0.022) and a family history of AF (OR 5.73, 95% CI 1.21 to 27.23, p = 0.028) each were independently associated with having vagal activity provoke an episode. Patients with PAF and alcohol triggers were more likely to have vagal triggers (OR 10.32, 95% CI 1.05 to 101.42, p = 0.045). In conclusion, alcohol consumption and vagal activity elicit PAF significantly more often than SVT. Alcohol and vagal triggers often were found in the same patients with PAF, raising the possibility that alcohol may precipitate AF by vagal mechanisms.

Slow conduction and gap junction remodeling in murine ventricle after chronic alcohol ingestion

BACKGROUND

Long-term heavy alcohol drinkers are prone to the development of cardiac arrhythmia. To understand the mechanisms, we evaluated the cardiac structural and electrophysiological changes in mice chronically drinking excessive alcohol.

RESULTS

Male C57BL/6J mice were given 36% alcohol in the drinking water. Those given blank water were used as control. Twelve weeks later, the phenotypic characteristics of the heart, including gap junctions and electrical properties were examined. In the alcohol group the ventricles contained a smaller size of cardiomyocytes and a higher density of capillary networks, compared to the control. Western blots showed that, after drinking alcohol, the content of connexin43 (Cx43) protein in the left ventricle was increased by 18% (p < 0.05). Consistently, immunoconfocal microscopy demonstrated that Cx43 gap junctions were up-regulated in the alcohol group with a disorganized distribution, compared to the control. Optical mapping showed that the alcohol group had a reduced conduction velocity (40 ± 18 vs 60 ± 7 cm/sec, p < 0.05) and a higher incidence of ventricular tachyarrhythmia (62% vs 30%, p < 0.05).

CONCLUSION

Long-term excessive alcohol intake resulted in extensive cardiac remodeling, including changes in expression and distribution of gap junctions, growth of capillary network, reduction of cardiomyocyte size, and decrease of myocardial conduction.

Effect of ethanol on action potential and ionic membrane currents in rat ventricular myocytes

AIM

Even though alcohol intoxication is often linked to arrhythmias, data describing ethanol effect on cardiac ionic channels are rare. In addition, ethanol is used as a solvent of hydrophobic compounds in experimental studies. We investigated changes of the action potential (AP) configuration and main ionic membrane currents in rat cardiomyocytes under 20-1500 m(M) ethanol.

METHODS

  Experiments were performed on enzymatically isolated rat right ventricular myocytes using the whole cell patch-clamp technique at room temperature.

RESULTS

  Ethanol reversibly decelerated the upstroke velocity and decreased AP amplitude and duration at 0.2 and 3 Hz. The fast sodium current I(Na) , l-type calcium current I(Ca) and transient outward potassium current I(to) were reversibly inhibited in a concentration-dependent manner (50% inhibition at 446 ± 12, 553 ± 49 and 1954 ± 234 m(M), respectively, with corresponding Hill coefficients 3.1 ± 0.3, 1.1 ± 0.2 and 0.9 ± 0.1). Suppression of I(Na) and I(Ca) magnitude was slightly voltage dependent. The effect on I(Ca) and I(to) was manifested mainly as an acceleration of their apparent inactivations with a decreased slow and fast time constant respectively. As a consequence of marked differences in n(H) , sensitivity of the currents to ethanol at 10% inhibition decreases in the following order: I(Ca) (75 mm, 3.5‰), I(to) (170 m(M), 7.8‰) and I(Na) (220 m(M), 10.1‰).

CONCLUSION

  Our results suggest a slight inhibition of all the currents at ethanol concentrations relevant to deep alcohol intoxication. The concentration dependence measured over a wide range may serve as a guideline when using ethanol as a solvent.

Experimental models for studying the effects of ethanol on the myocardium

The ability to induce alcoholic cardiomyopathy has been tested in a variety of animal species. Myocardial alterations consistent with subclinical heart disease have been produced in many of these studies through a direct effect of ethanol or its metabolites upon the heart or a neurohumoral mechanism. In the rat most studies have, however, failed to finding diminished contractility in the basal state. In long-term animals the acute left ventricular responses to isoproterenol and calcium as well as pacing were reduced. Long-term studies in mongrel dogs fed 36 per cent of calories as ethanol produced an early decrease in left ventricular diastolic compliance related to interstitial collagen accumulation. Diminished contractility developed by four years. In addition to the morphologic evidence of distorted sarcoplasmic reticulum, in vitro experiments suggest important acute effects. Each mole of ethanol is bound tightly to each mole of protein comprising the Ca-ATPase pump, which is inhibited. Impaired uptake and binding of calcium by the sarcoplasmic reticulum has been observed in chronic alcohol models at one to two day intervals following the last exposure to ethanol. In addition, the flux of calcium ion does not appear normal in terms of access to contractile protein, where the calcium regulated inhibition of the troponin interaction with myosin is impaired. Experimental studies in a canine model of alcoholism revealed that the ventricular fibrillation threshold was moderately reduced in the basal state after 18 months and was diminished further after acute exposure.

Effects of alcohol on atrial fibrillation: myths and truths

Alcohol is the most consumed drug worldwide. Both acute and chronic alcohol use have been associated with cardiac arrhythmias, in particular atrial fibrillation, or so-called 'holiday heart syndrome'. Epidemiological, clinical and experimental studies have attempted to elucidate the mechanisms involved in this association. However, because most of these studies have shown conflicting results, the connection between ethanol and atrial arrhythmias remains controversial. Historical, epidemiological and pharmacological aspects of alcohol, as well as recent concepts on atrial fibrillation are reviewed. We then examine the literature and provide a critical point of view on the still elusive association between alcohol and atrial fibrillation.

Exposure-dependent effects of ethanol on the innate immune system

Extensive evidence indicates that ethanol (alcohol) has immunomodulatory properties. Many of its effects on innate immune response are dose dependent, with acute or moderate use associated with attenuated inflammatory responses, and heavy ethanol consumption linked with augmentation of inflammation. Ethanol may modify innate immunity via functional alterations of the cells of the innate immune system. Mounting evidence indicates that ethanol can diversely affect antigen recognition and intracellular signaling events, which include activation of mitogen activated protein kinases, and NFkappaB, mediated by Toll-like receptors, leading to altered inflammatory responses. The mechanism(s) underlying these changes may involve dose-dependent effects of ethanol on the fluidity of cell membrane, resulting in interference with the timely assembly or disassembly of lipid rafts. Ethanol could also modify cell activation by specific interactions with cell membrane molecules.

Properties of thiamin transport in isolated perfused hearts of chronically alcoholic guinea pigsThis article is one of a selection of papers published in the special issue Bridging the Gap: Where Progress in Cardiovascular and Neurophysiologic Research Meet

The aim of this study was to determine the mechanism of transport of 14C-thiamin in the hearts of healthy (nonalcoholic) and chronically alcoholic guinea pigs. We used the single-pass, paired-tracer dilution method on isolated and retrogradely perfused guinea pig hearts. The maximal cellular uptake (Umax) and total cellular uptake (Utot) of 14C-thiamin were determined under control conditions and under influence of possible modifiers. We tested how the presence of unlabeled thiamin, metabolic inhibitors, or absence of sodium ions influence the transport of 14C-thiamin. The results of our experiments show that the transport of 14C-thiamin is specific and energy-dependent and that its properties are significantly changed under the influence of chronic alcoholism. The latter effect occurs by increase in both Umax and Utot, as a manifestation of a compensatory mechanism in thiamin deficiency.

Characterization of the Acute Cardiac Electrophysiologic Effects of Ethanol in Dogs

BACKGROUND

Alcohol has been related to atrial fibrillation (holiday heart syndrome), but its electrophysiologic actions remain unclear.

METHODS

We evaluated the effects of alcohol in 23 anesthetized dogs at baseline and after 2 cumulative intravenous doses of ethanol: first dose 1.5 ml/kg (plasma level 200 mg/dl); second dose 1.0 ml/kg (279 mg/dl). In 13 closed-chest dogs (5 with intact autonomic nervous system, 5 under combined autonomic blockade and 3 sham controls), electrophysiologic evaluation and monophasic action potential (MAP) recordings were undertaken in the right atrium and ventricle. In 5 additional dogs, open-chest biatrial epicardial mapping with 8 bipoles on Bachmann's bundle was undertaken. In the remaining 5 dogs, 2D echocardiograms and ultrastructural analysis were performed.

RESULTS

In closed-chest dogs with intact autonomic nervous system, ethanol had no effects on surface electrocardiogram and intracardiac variables. At a cycle length of 300 milliseconds, no effects were noted on atrial and ventricular refractoriness and on the right atrial MAP. These results were not altered by autonomic blockade. No changes occurred in sham controls. In open-chest dogs, ethanol did not affect inter-atrial conduction time, conduction velocity, and wavelength. Atrial arrhythmias were not induced in any dog, either at baseline or after ethanol. Histological and ultrastructural findings were normal but left ventricular (LV) ejection fraction decreased in treated dogs (77 vs. 73 vs. 66%; p = 0.04).

CONCLUSION

Ethanol at medium and high doses depresses LV systolic function but has no effects on atrial electrophysiological parameters. These findings suggest that acute alcoholic intoxication does not directly promote atrial arrhythmias.

Effect of ethanol on the electrophysiological characteristics of pulmonary vein cardiomyocytes

Ethanol consumption has been considered to contribute to the occurrences of paroxysmal atrial fibrillation. Pulmonary veins are known to initiate atrial fibrillation. This study investigated whether ethanol may induce atrial fibrillation through increasing arrhythmogenic activity of pulmonary vein cardiomyocytes. Using the whole-cell clamp technique, the action potential and ionic currents were investigated in rabbit single pulmonary vein beating cardiomyocytes with and without (control) incubation of ethanol. Compared with control cardiomyocytes, pulmonary vein cardiomyocytes receiving 0.3 mg/ml or 1 mg/ml ethanol had shorter action potential duration, but had similar beating rates (2.6+/-1.3, 2.7+/-1.2, 2.7+/-1.2 Hz) and incidences (45%, 41%, 32%) of delayed after depolarization. Pulmonary vein cardiomyocytes receiving ethanol had smaller L-type Ca(2+) currents and larger transient outward currents, but had similar transient inward, delayed rectified outward, inward rectified and pacemaker currents. These results suggest that ethanol has no direct effect on the arrhythmogenic potential of pulmonary vein cardiomyocytes.

Ethanol and hormesis

This article provides a detailed assessment of the toxicological and pharmacological literature concerning alcohol-induced biphasic dose-response relationships. The assessment reveals that alcohol-induced hormetic-like dose-response relationships are commonly observed, highly generalizeable according to model and endpoint and quantitative feature of the dose response. These findings have important implications affecting study design, animal model, and endpoint selection as well as clinical applications.

Alcohol, cardiac arrhythmias and sudden death

Studies in experimental animals have shown varying and apparently opposite effects of alcohol on cardiac rhythm and conduction. Given acutely to non-alcoholic animals, ethanol may even have anti-arrhythmic properties whereas chronic administration clearly increases the animals' susceptibility to cardiac arrhythmias. Chronic heavy alcohol use has been incriminated in the genesis of cardiac arrhythmias in humans. The evidence has come from clinical observations, retrospective case-control studies, controlled studies of consecutive admissions for arrhythmias, and prospective epidemiological investigations. Furthermore, electrophysiological studies have shown that acute alcohol administration facilitates the induction of tachyarrhythmias in selected heavy drinkers. The role of alcohol appears particularly conspicuous in idiopathic atrial fibrillation. Occasionally, ventricular tachyarrhythmias have also been provoked by alcohol intake. Several lines of evidence suggest that heavy drinking increases the risk of sudden cardiac death with fatal arrhythmia as the most likely mechanism. According to epidemiological studies this effect appears most prominent in middle-aged men and is only partly explained by confounding traits such as smoking and social class. The basic arrhythmogenic effects of alcohol are still insufficiently delineated. Subclinical heart muscle injury from chronic heavy use may be instrumental in producing patchy delays in conduction. The hyperadrenergic state of drinking and withdrawal may also contribute, as may electrolyte abnormalities, impaired vagal heart rate control, repolarization abnormalities with prolonged QT intervals and worsening of myocardial ischaemia or sleep apnoea. Most of what we know about alcohol and arrhythmias relates to heavy drinking. The effect of social drinking on clinical arrhythmias in non-alcoholic cardiac patients needs to be addressed further.

Cardiovascular effects of alcohol

The ingestion of one or two alcoholic drinks can affect heart rate, blood pressure, cardiac output, myocardial contractility, and regional blood flow. These actions generally are not clinically important. In the presence of cardiovascular disease, however, even such small quantities of alcohol might result in transient unfavorable hemodynamic changes. Moreover, alcohol abuse can produce cardiac arrhythmias, hypertension, cardiomyopathy, stroke, and even sudden death. In contrast, moderate alcohol use produces changes that have an overall favorable effect on atherosclerotic-related vascular diseases. Because cardiovascular disease due to atherosclerosis is the leading cause of death in Western society, this desirable effect of alcohol use outweighs its detrimental actions, resulting in favorable findings in population studies. Nevertheless, the body of evidence argues against encouraging alcohol use for its cardiovascular effects.

Arrhythmogenic and antiarrhythmic actions of substances of abuse: effects on triggered activity

Substances of abuse exert adrenergic and/or depressant actions on the cellular processes responsible for cytosolic calcium overload. This investigation attempted to determine whether substances of abuse, through catechol-mediated effects or cellular actions, elicit or inhibit the production of arrhythmias caused by delayed afterdepolarizations (DADs) and triggered activity (TA). The papillary muscles of rats and Purkinje fibers of dogs were superfused in vitro with Tyrode's solution at 37 degrees C. Intracellular microelectrodes were used to record membrane potentials. Overdrives failed to induce DADs and TA in the canine Purkinje fibers exposed to either Tyrode's solution alone, or containing ethanol or harmine. Instead, ethanol and harmine inhibited DADs and TA induced by overdrives in the presence of strophanthidin. On the contrary, in the presence of acetaldehyde and amphetamine, overdrives did produce TA, which was inhibited by propranolol. In conclusion, substances of abuse may either elicit or inhibit the production of DADs and TA, depending on the balance between adrenergic and depressant actions on the cellular mechanisms responsible for the calcium overload of the cytosol.

Effect of ethanol, haloperidol, and lorazepam on cardiac conduction and contraction

Haloperidol and lorazepam are commonly used to sedate ethanol (E)-intoxicated patients in emergency departments. This study was conducted to explore the role of ethanol in altering the potency of haloperidol and lorazepam with respect to cardiac conduction and contraction. For mechanical studies, isolated rat hearts were studied under isovolumetric conditions by using standard Langendorff technique. Hearts were perfused with Krebs-Heinseleit-Bicarbonate buffer containing haloperidol or lorazepam in concentrations ranging from 100 to 750 ng/ml (one heart per drug concentration). For both haloperidol and lorazepam individually, significant reductions in Left ventricular-generated pressure (LVGP) were observed at a concentration of 750 ng/ml (haloperidol = 2,250 nM and lorazepam = 2,000 nM). The addition of 20 and 65 mM ethanol shifted the concentration-response effect of haloperidol such that LVGP was significantly reduced at haloperidol = 500 and 300 ng/ml, respectively (p < 0.05 vs. basal control; paired t test). Ethanol produced no observable shift on the lorazepam concentration-response for LVGP. For electrophysiologic studies, hearts were perfused with haloperidol and lorazepam (300 ng/ml) +/- 65 mM ethanol. Compared with basal control, E + H significantly decreased heart rate (-74 +/- 12 beats/min) and increased His-ventricular conduction time (+7.6 +/- 1.5 ms vs. +1.7 +/- 0.6 ms for control hearts). Both haloperidol and EH significantly increased atrioventricular (AV) effective refractory period and the atrioventricular-His (AH) conduction interval. No significant changes in any electrophysiologic parameter were observed with ethanol or lorazepam perfused individually or with the combination of ethanol and lorazepam. Ethanol potentiates haloperidol-induced electromechanical depression of isolated rat hearts. Ethanol had no such effect on lorazepam.

Ethanol inhibition of Ca2+ and Na+ currents in the guinea-pig heart

The effects of ethanol on L-type Ca2+ and fast Na+ currents (ICa and INa, respectively) were examined using the whole-cell patch-clamp experiments on guinea-pig ventricular cells. At a clinically relevant concentration of 24 mM, ethanol slightly but significantly shortened the action potential duration, and reduced the ICa by 7 +/- 4% (mean +/- S.D.). This concentration of ethanol did not affect INa, but a lethal concentration of ethanol (80 mM) significantly inhibited INa by 13 +/- 5%. The voltage dependence of INa activation was not affected by ethanol, whereas the inhibitions of ICa by 80 mM ethanol and INa by 240 mM were both accompanied by a several mV shift in the channel availability curve toward more negative potentials, suggesting that the channels in the inactivated state are more susceptible to ethanol. The ICa inhibition by ethanol at clinically relevant concentrations could contribute to a negative inotropic effect, action potential shortening and development of arrhythmias, while the pathophysiological significance of ethanol inhibition of INa seems less important.

Interactions of ethanol and quinidine on contractility and myocyte action potential in the rat ventricle

The combined effects of ethanol and quinidine on cardiac electromechanical coupling are unknown, but both drugs affect cardiac conduction and can cause myocardial depression. Isolated left ventricular papillary and ventricular myocytes were used to assess the combined effects of quinidine and ethanol on the electrophysiologic and mechanical properties of rat myocardium. The combination of quinidine (1-300 microM) and ethanol (120-240 mg/dL) depressed active papillary muscle tension within the clinically useful concentration range. In electrophysiologic studies of isolated ventricular myocytes, quinidine prolonged the action potential duration at 50% (APD50) and 90% (APD90) repolarization, the absolute refractory period, and the relative refractory period, but decreased the maximum rate of change of depolarization in phase 0 (Vmax). When cells were exposed to ethanol (240 mg/dL) and quinidine (1.5 microM) together, a significant decrease in the quinidine-induced prolongation of the absolute refractory and relative refractory periods was seen. Additional changes in action potential parameters from the quinidine values included slight reductions in Vmax and in APD50 and APD90, but these reductions were not consistently displayed, nor were they statistically significant.

Effects of ethanol on the contractile function of the heart: a review

Chronic ethanol consumption leads to a number of alterations in the contractile function of the heart and is a leading cause of cardiomyopathy. Ethanol also has an acute negative inotropic effect mediated by direct interaction with cardiac muscle cells, although this action is often masked by indirect actions resulting from enhanced release of catecholamines in vivo. This article reviews the effects of ethanol on the contractile function of the heart. The specific targets affected by ethanol in cardiac muscle cells are discussed in terms of potential mechanisms underlying the depressions of contractility resulting from both acute and chronic actions of ethanol.

Ethanol increases defibrillation threshold in pigs

Alcohol ingestion has been associated with cardiac arrhythmias and may initiate fibrillation in patients with automatic defibrillators. The effect of alcohol on defibrillation efficacy is unknown. To assess the acute effects of alcohol on defibrillation efficacy, triplicate defibrillation thresholds (DFTs) were determined before and after intravenous administration of 25% ethanol. Fifty-two pigs were randomized into four groups: (1) control, 6 mL/kg of saline over 10 minutes (n = 12); (2) low dose, 6 mL/kg of 25% ethanol over 10 minutes (n = 12); (3) mid dose, 0.45 mL/kg per minute for 30 minutes followed by 0.045 mL/kg per minute for 45 minutes (n = 12); and (4) high dose, 0.6 mL/kg per minute for 30 minutes followed by 0.06 mL/kg per minute for 45 minutes (n = 16). Three coil defibrillating electrodes (Medtronic 6888) were sutured to the epicardium of the right and left ventricles for defibrillation shocks. Ventricular fibrillation was induced using alternating current and after 10 seconds of fibrillation, the minimum energy for defibrillation was established using sequential pulse defibrillation. Triplicate determinations were obtained before and after saline or ethanol infusion. Alcohol elevated DFT in a dose related manner. Control and low dose groups thresholds were unchanged, but the mid dose approached statistical significance (6.8 +/- 0.7 vs 7.6 +/- 0.9 J, 0.05 < P < 0.1) and the high dose was significantly elevated (8.5 +/- 0.7 vs 11.2 +/- 1.1 J, P < 0.01). Ventricular effective refractory periods and cycle lengths between fibrillatory waves did not differ before and after the high dose ethanol.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of nicotine and ethanol on rat atrial membrane potentials

The purpose of this research was to study the effects of nicotine and ethanol, alone and in combination, on cardiac membrane potentials (MP). Rat atrial preparations driven at 5 Hz were superfused with Tyrode's solution (37 degrees C) while recording MP with intracellular microelectrodes. Nicotine concentrations below and including 6.2 x 10(-5) M did not affect MP. Within 15 s, nicotine 3.1 x 10(-3) M shortened the action potential duration (APD) and depressed the overshoot of the action potential (OS). This action was blocked by atropine. After 3 min, nicotine prolonged the APD and depressed Vmax of phase O, OS and the amplitude of the action potential (AAP), without affecting the resting membrane potential (RMP). Nifedipine blocked the depression of the OS while tetraethylammonium chloride blocked the prolongation of the APD. Acute exposure to ethanol depressed OS and AAP and shortened APD, but it did not affect RMP or Vmax of phase O. When nicotine and ethanol were administered simultaneously, the APD-prolonging effects of nicotine prevailed. The influence of chronic ethanol ingestion on the acute action of nicotine and/or ethanol was studied in rats pair-fed a liquid diet with (ER) or without (NR) ethanol (35% of total caloric intake) for 24 weeks. Chronic ethanol ingestion accentuated the depressant effect of nicotine 3.1 x 10(-3) M on OS and AAP, but it did not modify the APD-prolonging action of nicotine. The same results were observed when ER and NR were exposed to nicotine and ethanol simultaneously.

Increased ventricular vulnerability in a chronic ethanol model despite reduced electrophysiologic responses to catecholamines

An increased incidence of sudden death has been reported in chronic alcoholism. To assess electrical vulnerability of the heart, action potential responses, and the role of the sympathetic system, a well-nourished canine model has been studied intact under chloralose anesthesia after 1 year of ethanol consumption at 36% of caloric intake. Two alcoholic groups were compared with controls (Group 1). In Group 2 myocardial vulnerability was assessed after chronic EtOH and superimposed acute administration. In Group 3 basal vulnerability was related to circulating norepinephrine and release of neurohormone from the myocardium. Subsequently the responsiveness to catecholamine infusion was determined. To assess vulnerability an electrode catheter was placed in the right ventricular apex. The basal ventricular fibrillation threshold (VFT) was reduced to 27 +/- 3 ma in Group 2 versus 43 +/- 1.0 in Group 1. Acute infusion of ethanol in Group 2 further reduced the threshold. Group 3 had a reduced basal VFT. Baseline arterial plasma levels of norepinephrine were 8-fold higher and coronary venous levels 13 times higher in the alcoholic group than in Group 1. However, VFT was not responsive to infused epinephrine, compared with Group 1 controls. In vitro study of superfused ventricular tissue from Group 3 revealed that basal action potential amplitude, overshoot, and resting potential were comparable with normals. Basal repolarization time (90%) was 198 +/- 12 msec in Group 3 versus 215 +/- 6 msec in Group 1 (p less than 0.05). After acute EtOH, repolarization time was shortened to 170 +/- 8.6 in Group 1 at 90 mg% ethanol (p less than 0.002), with minimal further change up to 280 mg%.(ABSTRACT TRUNCATED AT 250 WORDS)

Inotropic effects of ethanol and dihydropyridines on the guinea pig heart atrial muscle

The effects of ethanol and/or dihydropyridines (DHPs) on force of contraction of atrial muscle were studied. Guinea pig atrial strips superfused with Tyrode's solution (36 degrees C) were driven (1.5 Hz) while recording muscle tension. Bay K 8644 (BAYK) increased, while nimodipine or ethanol reduced, the peak tension developed and the maximum velocity of development of tension. The effects of ethanol were readily reversible, but those of the DHPs were not. The combined actions of ethanol and DHPs were the result of the synergism or antagonism of the drugs tested. The shorter duration of the action of ethanol resulted in the effect of DHPs being still evident well after the exposure to the drugs ended. In summary, ethanol and nimodipine exerted depressant actions on atrial contractile force, while BAYK had opposite effects. The different mechanisms of action may explain the different duration of the effects of ethanol (physical agent) and DHPs (receptor-binding chemicals).

Effects of acetaldehyde on membrane potentials of sinus node pacemaker fibers

The experiments reported here were performed to characterize the effects of acetaldehyde on membrane potentials (MP) of sinus node subsidiary pacemaker fibers in the absence and presence of adrenergic and cholinergic blockade. Guinea pig sinoatrial preparations were superfused with Tyrode's solution at 37 degrees C while electrically stimulated at 5 Hz. Intracellular microelectrodes were used to record the MP of sinus node subsidiary pacemaker fibers. Acetaldehyde 3 x 10(-6) M and 3 x 10(-3) M had no effect on maximum diastolic potential (MDP), while 3 x 10(-5) M and 3 x 10(-2) M exerted a depolarizing effect on the MDP, without affecting the overshoot (OS). The fall in MDP was associated with a reduction in the amplitude of the action potential (AAP) and the maximum velocity of phase 0 (Vmax 0). The depressant effect of acetaldehyde on MDP was not abolished by adrenergic blockers or atropine. Concentrations of acetaldehyde between 3 x 10(-5) and 3 x 10(-2) M prolonged the action potential duration (APD). Acetaldehyde 3 x 10(-3) M did not affect MDP even in the presence of atropine or propranolol. The APD-prolonging effect of acetaldehyde was not abolished by adrenergic blockers. In summary, the actions of acetaldehyde on MDP and APD were independent of adrenergic and cholinergic mechanisms.

Membrane actions of ethanol on rabbit sino-atrial node studied by voltage clamp method

Electrophysiological effects of ethanol on rabbit sino-atrial node were studied by means of the double-microelectrode voltage clamp method. In spontaneously beating preparations, ethanol (above 1%) decreased the maximum rate of depolarization of the action potential. Furthermore, 3% ethanol produced a significant decrease in the action potential amplitude, the action potential duration at 50% repolarization and the rate of the diastolic depolarization. Of the current systems, voltage clamp studies showed that ethanol reduced the slow inward current, the time-dependent potassium outward current and the hyperpolarization activated inward current. These observations indicate that ethanol does not have an effect on a single current system, but directly modifies the spontaneous discharge of sino-atrial node pacemaker cells due to a reduction of the time-dependent current systems.

Effects of acetaldehyde on the automaticity of the guinea pig sinus node

The objective of this investigation was to characterize the effects of acetaldehyde (ACA) on sinus node automaticity (SNA). Guinea pig sinoatrial preparations superfused with Tyrode's solution at 37 degrees C were used. Intracellular microelectrodes were used to monitor SN rate (SNR). Acetaldehyde 3 X 10(-5) M had no effect on SNR, while 3 X 10(-3) M had a positive chronotropic action. The increase in SNR was associated with an increase in the slope of the slow diastolic depolarization (SDD) of subsidiary pacemaker fibers, with no change in the maximum diastolic potential (MDP). Acetaldehyde 3 X 10(-2) M exerted a biphasic effect: the SNR was enhanced and then depressed. Propranolol blocked the positive component of this chronotropic action. The negative component was not modified by propranolol, phentolamine, or atropine. It is concluded that ACA exerts both positive and negative chronotropic actions on the guinea pig sinus node. The positive component of this biphasic effect is mediated through a beta-adrenergic mechanism and it is associated with an increase in the SDD. The negative component is not due to alpha- or beta-adrenergic or muscarinic stimulation.

Effects of alcohol on experimental atrial fibrillation

The association of alcohol abuse, especially binge drinking, and atrial fibrillation, recently termed "holiday heart," has been recognized for some time. The effects of alcohol on atrial fibrillation, however, have not been studied. Accordingly, measurements of hemodynamics and duration of electrically induced atrial fibrillation were made in alpha-chloralose anesthetized dogs during the 30 min before and during a 30-min intravenous infusion of 1.7 g/kg of ethanol (25%, v/v), which produced an average infusion concentration of 254 +/- 21 mg/dl. Average cardiac output, left ventricular (LV) peak dp/dt, and pulmonary artery mean pressure did not change, whereas LV systolic (116 +/- 8 to 107 +/- 9 mm Hg, p less than 0.05) and aortic mean (95 +/- 7 to 87 +/- 9 mmHg, p less than 0.05) pressures decreased. Heart rate and atrioventricular conduction in sinus rhythm, and atrial and ventricular activity in atrial fibrillation also did not change. Despite a decrease in arterial pH, duration of atrial fibrillation decreased (356 +/- 143 to 93 +/- 38 sec, p less than 0.05). Moreover, at 15 min, when average ethanol concentration was 208 +/- 20 mg/dl, and aortic mean pressure (95 +/- 7 to 85 +/- 8 mm Hg, p less than 0.05), pulmonary artery mean pressure (16 +/- 2 to 14 +/- 2 mm Hg, p less than 0.05), and LV peak dp/dt (1563 +/- 143 to 1285 +/- 167 mm Hg-sec-1, p less than 0.05) were reduced, duration of atrial fibrillation was less than control (356 +/- 143 to 114 +/- 56 sec, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term intracoronary ethanol administration electrophysiologic and morphologic effects

The long-term intracoronary infusion of ethanol was used to evaluate the potential of ethanol to produce myocardial injury and cardiac rhythm disturbances. In 22 dogs, electrophysiologic testing was performed 48 hr after cessation of alcohol administration. Multiple premature ventricular beats occurred spontaneously in 3 dogs with spontaneous sustained monomorphic ventricular tachycardia observed in 1 dog. Provocative ventricular pacing produced ventricular tachycardia lasting 20 or more beats in 13 animals with sustained tachycardia observed in 3 animals. Provocative ventricular pacing in the presence of lidocaine or epinephrine produced sustained ventricular tachycardia in an additional 4 dogs. The electrophysiologic properties of Purkinje fibers from the zone receiving ethanol were altered when compared to the control zone. The resting membrane potential was decreased (-76 +/- 2 mV vs. -85 +/- mV, p less than 0.001) with a decrease in action potential amplitude (91 +/- 4 vs. 109 +/- 2 mV, p less than 0.001) and phase 0 upstroke (231 +/- 27 vs. 456 +/- 25 V/sec, p less than 0.02). Prolonged refractoriness was observed in the ethanol zone without a prolongation of action potential duration. Intramural lesions observed within the left circumflex distribution varied from focal acute myofibrillar degeneration and necrosis to severe local scarring. The data suggest that intracoronary ethanol administration at human abuse levels of blood alcohol concentrations produces histologic and electrophysiologic injury in the canine heart. The electrophysiologic ch changes provide a substrate sufficient for the induction and maintenance of ventricular arrhythmia.

Effect of chronic acetaldehyde intoxication on ethanol tolerance and membrane fatty acids

Recent studies have suggested that acetaldehyde participates directly in the pathogenesis of alcoholism. Its action has been attributed mainly to its physico-chemical properties. Results of direct intoxication of laboratory animals with acetaldehyde have been reported, but only for short periods of exposure and at high doses. These are probably not representative of the conditions found during alcohol intoxication. The pulmonary route of administration described here enables long term intoxication with acetaldehyde, at levels corresponding to values measured during chronic ethanol intoxication. Chronic administration of acetaldehyde during 3 weeks induced a metabolic tolerance to ethanol as tested by the sleeping time after a challenge dose of ethanol; behavioural tolerance (measured by blood alcohol levels on waking) was not observed. At the end of the intoxication, phospholipid fatty acids of erythrocyte and synaptosome membranes were also analysed. Small changes in levels of the shorter fatty acids were observed in the phosphatidyl-choline fraction. By comparison with the effects of ethanol on the same membrane preparations, only a small part of this effect can be attributed to acetaldehyde. The first metabolite of ethanol has, however, a sure effect on the pattern of fatty acid phospholipids.

The effects of ethanol on the electrophysiology of calcium channels

Acute ethanol intoxication affects many systems in the body, especially the central nervous system. Because early experiments using axonal preparations required very high concentrations of ethanol to produce ionic current alterations, researchers turned their attention away from specific effects on electrogenesis and looked for effects at the synapse. The role of Ca2+ in the release of neurotransmitters was well known and was considered a possible site of action for ethanol. Indeed, several studies demonstrated that ethanol alters Ca2+ binding or transport in synaptosomes and neural tissue. The purpose of this chapter is to present electrophysiological evidence for the acute effects of ethanol on calcium channels. It is necessary first to define the relevant ethanol concentrations and to describe the characteristics of tissue preparations that may best help to determine the effects of ethanol. A discussion of these two points along with a brief synopsis of the role of Ca2+ in excitable tissues is presented. This is followed by a discussion of the effects of ethanol on Ca2+ and Ca2+-activated conductances in both nonmammalian and mammalian cells, and a model is presented in an attempt to unify the experimental evidence of the acute effects of ethanol.

The effect of ethanol on arrhythmias and myocardial necrosis in rats with coronary occlusion and reperfusion

Ethanol (1, 2 and 3 g/kg, intravenously) decreased the severity of the ischemic arrhythmias in rats with ligation of the left coronary artery and subsequent coronary reperfusion. Reperfusion arrhythmias occurring intensively after occlusion times of 5 and 15 min, respectively, were however not antagonized. Similar results were obtained in isolated perfused rat hearts with final concentrations of 4 and 6 mg ethanol/ml. In rats with reperfusion after 60 min of coronary occlusion, 2 g ethanol/kg significantly reduced the percentage of the ischemic area which underwent necrosis. Moreover, the increase in the wet weight/dry weight ratio of the lungs, as a measure of edema formation, was prevented. The ethanol effects are discussed in the light of present knowledge of the pathogenesis of arrhythmias and myocardial necrosis in experimental myocardial infarction.

Ethanol and heart disease. An underestimated contributing factor

With the number of chronic heavy users of ethanol in the United States estimated to be 15 to 20 million and the evidence increasing that ethanol causes serious cardiac metabolic disturbances, ethanol abuse is obviously a serious problem and most likely is an important contributing factor to cardiac morbidity and mortality. However, a direct cause-and-effect relationship between the biochemical dysfunctions produced by ethanol and the clinical entity of alcoholic cardiomyopathy has not been clearly established. What is lacking is a method to differentiate the damage secondary to ethanol abuse from that secondary to other causes. Sorely needed is a biochemical or anatomic marker (perhaps evaluated by serial myocardial biopsy) for alcoholic cardiomyopathy and a study to detect which cases of dilated cardiomyopathy indeed are due to ethanol-induced damage. Further longterm studies are also needed to demonstrate the benefits of abstinence upon large groups of patients, the effects of abstinence upon sudden death, and the effects of discontinuance of ethanol use for patients in the early stages of alcoholic cardiomyopathy. Ethanol is probably an underestimated contributing factor to cardiac disease. The importance of determining ethanol's impact on cardiovascular morbidity and mortality is underscored by the facts that alcoholic heart disease is completely avoidable and is largely reversible by abstinence.

Cardiodepressant effects of ethanol on guinea-pig atria: presynaptic and postsynaptic components

Ethanol, at concentrations ranging from 0.5 to 1.5%, depressed myocardial contractility of electrically-stimulated guinea-pig atria. This effect was evident in preparations bathed with a low calcium concentration, but was progressively reduced by increasing the extracellular calcium. The same concentrations of ethanol produced a dose-dependent inhibition of the cardiac response to field stimulation of the adrenergic nerve terminals. This effect was again calcium-dependent. These results support the hypothesis that the pre- and postsynaptic components of the cardiodepressant effects of ethanol are due to a reduction in calcium availability both at the nerve endings and in the contractile cells.

Inhibition of hepatic aldehyde dehydrogenase by carbon tetrachloride: an in vitro study

In vitro inhibition of rat liver mitochondrial and microsomal aldehyde dehydrogenase (ALDH) under conditions of active CCl4 metabolism was investigated. Incubation of microsomes or mitochondria in the presence of NADPH alone caused significant, time-dependent inhibition of mitochondrial and microsomal ALDH. EDTA partially protected ALDH from inhibition. Incubation of microsomes or microsomes plus mitochondria in the presence of NADPH and CCl4 resulted in marked inhibition of microsomal and mitochondrial ALDH activity. The inhibition was both dose- and time-dependent and was relatively less in the presence of EDTA. It is proposed that the inhibition of membrane-bound ALDH may be one of the early events responsible for the genesis of CCl4-hepatotoxicity.

Cardiovascular effects of alcohol with particular reference to the heart

Alcohol has acute and chronic cardiovascular effects. Acutely, alcohol depresses cardiac function and alters regional blood flow. Even when withdrawn from alcohol for several days, alcoholics may still manifest evidence of left ventricular dysfunction. In some alcoholics a severe muscle disorder may ensue with the clinical features of a dilated cardiomyopathy. The concomitant presence of a thiamine deficiency or cirrhosis may produce hemodynamic changes that can obscure the clinical features of alcohol-induced heart muscle disease. Alcoholics may also develop acute myocardial infarction with patent coronary arteries; some may have cardiac arrhythmias even without other evidence of heart disease. Although epidemiological studies suggest that moderate users of alcohol have fewer coronary events than teetotalers, such studies also demonstrate a relation between alcohol abuse and hypertension and an increased occurrence of coronary disease. Thus, the injurious cardiovascular effects of alcohol must be considered when establishing recommendations for its use.