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de Lima Conceição MR, Teixeira-Fonseca JL, Marques LP, Souza DS, da Silva Alcântara F, Orts DJB, Roman-Campos D. Extracellular acidification reveals the antiarrhythmic properties of amiodarone related to late sodium current-induced atrial arrhythmia. Pharmacol Rep 2024; 76:585-599. [PMID: 38619735 DOI: 10.1007/s43440-024-00597-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Amiodarone (AMIO) is an antiarrhythmic drug with the pKa in the physiological range. Here, we explored how mild extracellular pH (pHe) changes shape the interaction of AMIO with atrial tissue and impact its pharmacological properties in the classical model of sea anemone sodium channel neurotoxin type 2 (ATX) induced late sodium current (INa-Late) and arrhythmias. METHOD Isolated atrial cardiomyocytes from male Wistar rats and human embryonic kidney cells expressing SCN5A Na+ channels were used for patch-clamp experiments. Isolated right atria (RA) and left atria (LA) tissue were used for bath organ experiments. RESULTS A more acidophilic pHe caused negative inotropic effects on isolated RA and LA atrial tissue, without modification of the pharmacological properties of AMIO. A pHe of 7.0 changed the sodium current (INa) related components of the action potential (AP), which was enhanced in the presence of AMIO. ATXinduced arrhythmias in isolated RA and LA. Also, ATX prolonged the AP duration and enhanced repolarization dispersion in isolated cardiomyocytes in both pHe 7.4 and pHe 7.0. Pre-incubation of the isolated RA and LA and isolated atrial cardiomyocytes with AMIO prevented arrhythmias induced by ATX only at a pHe of 7.0. Moreover, AMIO was able to block INa-Late induced by ATX only at a pHe of 7.0. CONCLUSION The pharmacological properties of AMIO concerning healthy rat atrial tissue are not dependent on pHe. However, the prevention of arrhythmias induced by INa-Late is pHe-dependent. The development of drugs analogous to AMIO with charge stabilization may help to create more effective drugs to treat arrhythmias related to the INa-Late.
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Affiliation(s)
- Michael Ramon de Lima Conceição
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo Botucatu Street, 862, Biological Science Building, 7th floor,, São Paulo, Brazil
| | - Jorge Lucas Teixeira-Fonseca
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo Botucatu Street, 862, Biological Science Building, 7th floor,, São Paulo, Brazil
| | - Leisiane Pereira Marques
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo Botucatu Street, 862, Biological Science Building, 7th floor,, São Paulo, Brazil
| | - Diego Santos Souza
- Department of Physiology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Fabiana da Silva Alcântara
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo Botucatu Street, 862, Biological Science Building, 7th floor,, São Paulo, Brazil
| | - Diego Jose Belato Orts
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo Botucatu Street, 862, Biological Science Building, 7th floor,, São Paulo, Brazil
| | - Danilo Roman-Campos
- Laboratory of CardioBiology, Department of Biophysics, Paulista School of Medicine, Federal University of Sao Paulo Botucatu Street, 862, Biological Science Building, 7th floor,, São Paulo, Brazil.
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Han B, Trew ML, Zgierski-Johnston CM. Cardiac Conduction Velocity, Remodeling and Arrhythmogenesis. Cells 2021; 10:cells10112923. [PMID: 34831145 PMCID: PMC8616078 DOI: 10.3390/cells10112923] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac electrophysiological disorders, in particular arrhythmias, are a key cause of morbidity and mortality throughout the world. There are two basic requirements for arrhythmogenesis: an underlying substrate and a trigger. Altered conduction velocity (CV) provides a key substrate for arrhythmogenesis, with slowed CV increasing the probability of re-entrant arrhythmias by reducing the length scale over which re-entry can occur. In this review, we examine methods to measure cardiac CV in vivo and ex vivo, discuss underlying determinants of CV, and address how pathological variations alter CV, potentially increasing arrhythmogenic risk. Finally, we will highlight future directions both for methodologies to measure CV and for possible treatments to restore normal CV.
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Affiliation(s)
- Bo Han
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, 79110 Freiburg im Breisgau, Germany;
- Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, 79104 Freiburg im Breisgau, Germany
- Department of Cardiovascular Surgery, The Fourth People’s Hospital of Jinan, 250031 Jinan, China
| | - Mark L. Trew
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand;
| | - Callum M. Zgierski-Johnston
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, 79110 Freiburg im Breisgau, Germany;
- Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany
- Correspondence:
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Skjeflo GW, Nordseth T, Loennechen JP, Bergum D, Skogvoll E. ECG changes during resuscitation of patients with initial pulseless electrical activity are associated with return of spontaneous circulation. Resuscitation 2018; 127:31-36. [PMID: 29621571 DOI: 10.1016/j.resuscitation.2018.03.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/09/2018] [Accepted: 03/31/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pulseless electrical activity (PEA) is a frequent initial rhythm in cardiac arrest, and ECG characteristics have been linked to prognosis. The aim of this study was to examine the development of ECG characteristics during advanced life support (ALS) and cardiopulmonary resuscitation (CPR) in cardiac arrest with initial PEA, and to assess any association with survival. METHODS Patients with in-hospital cardiac arrest with initial PEA at St. Olav Hospital (Trondheim, Norway) over a three-year period were included. A total of 2187 combined observations of QRS complex rate (heart rate) and QRS complex width for the duration of ALS were determined from defibrillator recordings from 74 episodes of cardiac arrest. RESULTS Increasing heart rate and decreasing QRS complex width during ALS was significantly more prevalent in patients who obtained return of spontaneous circulation compared to patients who were declared dead. CONCLUSION Changes in ECG characteristics during ALS in cardiac arrest presenting as PEA are related to prognosis. An increase in heart rate was observed in the last 3-6 min before ROSC was obtained.
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Affiliation(s)
- Gunnar Waage Skjeflo
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway.
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway; St. Olav University Hospital, Department of Anesthesia and Intensive Care Medicine, NO-7006 Trondheim, Norway
| | - Jan Pål Loennechen
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway; St. Olav University Hospital, Department of Cardiology, NO-7006 Trondheim, Norway
| | - Daniel Bergum
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway; St. Olav University Hospital, Department of Anesthesia and Intensive Care Medicine, NO-7006 Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway; St. Olav University Hospital, Department of Anesthesia and Intensive Care Medicine, NO-7006 Trondheim, Norway
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Kuzmiak-Glancy S, Jaimes R, Wengrowski AM, Kay MW. Oxygen demand of perfused heart preparations: how electromechanical function and inadequate oxygenation affect physiology and optical measurements. Exp Physiol 2016; 100:603-16. [PMID: 25865254 DOI: 10.1113/ep085042] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/09/2015] [Indexed: 01/22/2023]
Abstract
NEW FINDINGS What is the topic of this review? This review discusses how the function and electrophysiology of isolated perfused hearts are affected by oxygenation and energy utilization. The impact of oxygenation on fluorescence measurements in perfused hearts is also discussed. What advances does it highlight? Recent studies have illuminated the inherent differences in electromechanical function, energy utilization rate and oxygen requirements between the primary types of excised heart preparations. A summary and analysis of how these variables affect experimental results are necessary to elevate the physiological relevance of these approaches in order to advance the field of whole-heart research. The ex vivo perfused heart recreates important aspects of in vivo conditions to provide insight into whole-organ function. In this review we discuss multiple types of ex vivo heart preparations, explain how closely each mimic in vivo function, and discuss how changes in electromechanical function and inadequate oxygenation of ex vivo perfused hearts may affect measurements of physiology. Hearts that perform physiological work have high oxygen demand and are likely to experience hypoxia when perfused with a crystalloid perfusate. Adequate myocardial oxygenation is critically important for obtaining physiologically relevant measurements, so when designing experiments the type of ex vivo preparation and the capacity of perfusate to deliver oxygen must be carefully considered. When workload is low, such as during interventions that inhibit contraction, oxygen demand is also low, which could dramatically alter a physiological response to experimental variables. Changes in oxygenation also alter the optical properties of cardiac tissue, an effect that may influence optical signals measured from both endogenous and exogenous fluorophores. Careful consideration of oxygen supply, working condition, and wavelengths used to acquire optical signals is critical for obtaining physiologically relevant measurements during ex vivo perfused heart studies.
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Affiliation(s)
- Sarah Kuzmiak-Glancy
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Rafael Jaimes
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Anastasia M Wengrowski
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Matthew W Kay
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA.,Department of Pharmacology and Physiology, The George Washington University, Washington, DC, USA
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Entz M, George SA, Zeitz MJ, Raisch T, Smyth JW, Poelzing S. Heart Rate and Extracellular Sodium and Potassium Modulation of Gap Junction Mediated Conduction in Guinea Pigs. Front Physiol 2016; 7:16. [PMID: 26869934 PMCID: PMC4735342 DOI: 10.3389/fphys.2016.00016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/12/2016] [Indexed: 11/29/2022] Open
Abstract
Background: Recent studies suggested that cardiac conduction in murine hearts with narrow perinexi and 50% reduced connexin43 (Cx43) expression is more sensitive to relatively physiological changes of extracellular potassium ([K+]o) and sodium ([Na+]o). Purpose: Determine whether similar [K+]o and [Na+]o changes alter conduction velocity (CV) sensitivity to pharmacologic gap junction (GJ) uncoupling in guinea pigs. Methods: [K+]o and [Na+]o were varied in Langendorff perfused guinea pig ventricles (Solution A: [K+]o = 4.56 and [Na+]o = 153.3 mM. Solution B: [K+]o = 6.95 and [Na+]o = 145.5 mM). Gap junctions were inhibited with carbenoxolone (CBX) (15 and 30 μM). Epicardial CV was quantified by optical mapping. Perinexal width was measured with transmission electron microscopy. Total and phosphorylated Cx43 were evaluated by western blotting. Results: Solution composition did not alter CV under control conditions or with 15μM CBX. Decreasing the basic cycle length (BCL) of pacing from 300 to 160 ms decreased CV uniformly with both solutions. At 30 μM CBX, a change in solution did not alter CV either longitudinally or transversely at BCL = 300 ms. However, reducing BCL to 160 ms caused CV to decrease more in hearts perfused with Solution B than A. Solution composition did not alter perinexal width, nor did it change total or phosphorylated serine 368 Cx43 expression. These data suggest that the solution dependent CV changes were independent of altered perinexal width or GJ coupling. Action potential duration was always shorter in hearts perfused with Solution B than A, independent of pacing rate and/or CBX concentration. Conclusions: Increased heart rate and GJ uncoupling can unmask small CV differences caused by changing [K+]o and [Na+]o. These data suggest that modulating extracellular ionic composition may be a novel anti-arrhythmic target in diseases with abnormal GJ coupling, particularly when heart rate cannot be controlled.
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Affiliation(s)
- Michael Entz
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA; Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA
| | - Sharon A George
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA; Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA
| | - Michael J Zeitz
- Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State University Roanoke, VA, USA
| | - Tristan Raisch
- Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA; Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA
| | - James W Smyth
- Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA; Department of Biological Sciences, College of Science, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA
| | - Steven Poelzing
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA; Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA; Department of Biological Sciences, College of Science, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA
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Huang J, Dosdall DJ, Cheng KA, Li L, Rogers JM, Ideker RE. The importance of Purkinje activation in long duration ventricular fibrillation. J Am Heart Assoc 2014; 3:e000495. [PMID: 24584738 PMCID: PMC3959715 DOI: 10.1161/jaha.113.000495] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The mechanisms that maintain long duration ventricular fibrillation (LDVF) are unclear. The difference in distribution of the Purkinje system in dogs and pigs was explored to determine if Purkinje activation propagates to stimulate working myocardium (WM) during LDVF and WM pacing. METHODS AND RESULTS In-vivo extracellular recordings were made from 1044 intramural plunge and epicardial plaque electrodes in 6 pig and 6 dog hearts. Sinus activation propagated sequentially from the endocardium to the epicardium in dogs but not pigs. During epicardial pacing, activation propagated along the endocardium and traversed the LV wall almost parallel to the epicardium in dogs, but in pigs propagated away from the pacing site approximately perpendicular to the epicardium. After 1 minute of VF, activation rate near the endocardium was significantly faster than near the epicardium in dogs (P<0.01) but not pigs (P>0.05). From 2 to 10 minutes of LDVF, recordings exhibiting Purkinje activations were near the endocardium in dogs (P<0.01) but were scattered transmurally in pigs, and the WM activation rate in recordings in which Purkinje activations were present was significantly faster than the WM activation rate in recordings in which Purkinje activations were absent (P<0.01). In 10 isolated perfused dog hearts, the LV endocardium was exposed and 2 microelectrodes were inserted into Purkinje and adjacent myocardial cells. After 5 minutes of LDVF, mean Purkinje activation rate was significantly faster than mean WM activation rate (P<0.01). CONCLUSION These extracellular and intracellular findings about activation support the hypothesis that Purkinje activation propagates to stimulate WM during sinus rhythm, pacing, and LDVF.
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Affiliation(s)
- Jian Huang
- Cardiac Rhythm Management Laboratory, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL
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King JH, Huang CLH, Fraser JA. Determinants of myocardial conduction velocity: implications for arrhythmogenesis. Front Physiol 2013; 4:154. [PMID: 23825462 PMCID: PMC3695374 DOI: 10.3389/fphys.2013.00154] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/10/2013] [Indexed: 12/19/2022] Open
Abstract
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 (INa); the axial resistance (ra) to local circuit current flow between cells; their membrane capacitances (cm); and to the geometrical relationship between successive myocytes within cardiac tissue. These determinants are altered by a wide range of pathophysiological conditions. Firstly, INa 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, ra, 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 ra or cm 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.
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Affiliation(s)
- James H King
- Physiological Laboratory, Department of Physiology, Development and Neuroscience, University of Cambridge Cambridge, UK
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HUELSING DELILAHJ, POLLARD ANDREWE. MEMBRANE AND TISSUE LEVEL CONTRIBUTIONS TO PURKINJE-VENTRICULAR INTERACTIONS: A MODEL STUDY. J BIOL SYST 2011. [DOI: 10.1142/s0218339099000280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purkinje-to-ventricular (P-to-V) propagation and electrotonic modulation of repolarization at discrete Purkinje-ventricular junctions (PVJs) depend on differences in the ionic currents and tissue structure of the P network and the V myocardium. We used computer simulations to assess these membrane and tissue level contributions to P-V interactions. At the membrane level, we used the DiFrancesco-Noble membrane equations to model P ionic kinetics and the Luo-Rudy dynamic membrane equations to model V ionic kinetics. At the tissue level, we modeled the P network as a layer of branching cables, and we modeled a single myocardial sheet with an anisotropic layer of excitable cells. P-to-V propagation was enhanced at the tissue level when multiple wavefronts in the branching P network collided at the PVJ. At the membrane level, P-to-V propagation was enhanced by a reduced transient outward current (Ito) in the P layer. Repolarization at the PVJ was also modulated by both membrane and tissue level contributions. Under nominal conditions, action potential duration (APD) shortened in the P layer and prolonged in the V layer. However, when the V mass was reduced, both P and V cell APDs shortened during coupling with nominal Ito. Subsequent Ito inhibition restored coupling-induced prolongation of the V action potential in the reduced V mass. These results suggest that under physiologic conditions, both membrane and tissue level contributions to P-V interactions are important, while membrane level contributions become even more important under pathologies that reduce the difference in P and V tissue size, particularly in the setting of healed myocardial infarction.
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Affiliation(s)
- DELILAH J. HUELSING
- Cardiac Rhythm Management Lab and Department of Biomedical Engineering, University of Alabama-Birmingham, Birmingham, AL 35294, USA
| | - ANDREW E. POLLARD
- Cardiac Rhythm Management Lab and Department of Biomedical Engineering, University of Alabama-Birmingham, Birmingham, AL 35294, USA
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Caldwell JC, Burton FL, Cobbe SM, Smith GL. Slowing of Electrical Activity in Ventricular Fibrillation is Not Associated with Increased Defibrillation Energies in the Isolated Rabbit Heart. Front Physiol 2011; 2:11. [PMID: 21519386 PMCID: PMC3078558 DOI: 10.3389/fphys.2011.00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 03/09/2011] [Indexed: 11/13/2022] Open
Abstract
Prolonged out-of-hospital ventricular fibrillation (VF) arrests are associated with reduced ECG dominant frequency (DF) and diminished defibrillation success. Partial reversal of ischemia increases ECG DF and improves defibrillation outcome. We have investigated the metabolic components of ischemia responsible for the decline in ECG DF and defibrillation success. Isolated Langendorff-perfused rabbit hearts were loaded with the voltage-sensitive dye RH237. Using a photodiode array, epicardial membrane potentials were recorded at 252 sites (15 mm × 15 mm) on the anterior surface of the left and right ventricles. Simultaneously, a global ECG was recorded. VF was induced by burst pacing, and after 60s, perfusion was either reduced to 6 ml/min or the perfusate composition changed to impose hypoxia (95% N(2)/5% CO(2)), pH 6.7 (80% O(2)/20% CO(2)), or hyperkalemia (8 mM). Using fast Fourier transform, power spectra were created from the optical signals and the global ECG. The optical power spectra were summated to give a global power spectrum (pseudoECG). At 600 s the minimum defibrillation voltage (MDV) was determined by step-up protocol. During VF, the ECG and pseudoECG DF were reduced by low-flow ischemia (9.0 ± 1.0 Hz, p < 0.01, n = 5) and raised [K(+)](o) (12.2 ± 1.3 Hz, p < 0.05, n = 7) compared to control (19.2 ± 1.5 Hz, n = 20), but were unaffected by acidic pH(o) (16.7 ± 1.1 Hz, n = 11) and hypoxia (14.0 ± 1.2 Hz, n = 10). In contrast, the MDV was raised by acidic pH (156.1 ± 26.4 V, p < 0.001) and hypoxia (154.1 ± 22.1 V, p < 0.01) compared to control (65.6 ± 2.3 V), but comparable changes were not observed in low-flow ischemia (61.0 ± 0.5 V) or raised [K(+)](o) (56 ± 3 V). In summary, different metabolites are responsible for the reduction in DF and the increase in defibrillation energy during ischemic VF.
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Affiliation(s)
- Jane C Caldwell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow Glasgow, UK
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ITO I, KONO K, SHINBO G, TADOKORO K, ABE C, TAKEMURA N, IEMURA T, MATSUHASHI N, NAKANO N, OTA S, ISHIMITSU T, MATSUOKA H. Implantable cardioverter defibrillator in maintenance hemodialysis patients with ventricular tachyarrhythmias: A single-center experience. Hemodial Int 2009; 13:48-54. [DOI: 10.1111/j.1542-4758.2009.00330.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Spitzer KW, Pollard AE, Yang L, Zaniboni M, Cordeiro JM, Huelsing DJ. Cell-to-cell electrical interactions during early and late repolarization. J Cardiovasc Electrophysiol 2006; 17 Suppl 1:S8-S14. [PMID: 16686687 DOI: 10.1111/j.1540-8167.2006.00379.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac electrical activity is significantly affected by variations in the conductance of gap junctions that connect myocytes to one another. To better understand how intrinsic (single cell) electrical activity is modulated by junctional conductance, we used a two-myocyte coupling system in which physically separate cells were electrically coupled via a variable resistance set by the investigator. This brief review summarizes our findings regarding: (1) the effect of the early phase of action potential repolarization (phase 1) and transient outward current (I(to)) on action potential conduction, and (2) the effect of coupling on the action potential plateau (late repolarization). We found that inhibition of I(to) markedly increased the ability of action potentials to propagate from cell-to-cell when junctional conductance was low. Electrically coupling two myocytes together also suppressed their beat-to-beat variability in action potential duration and contraction. Similarly, early afterdepolarizations (EADS) were readily suppressed by connecting a normal myocyte to one generating EADs. This high sensitivity of the plateau to variations in junctional interactions arises from the large increase in membrane resistance that occurs during this phase of the action potential.
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Affiliation(s)
- Kenneth W Spitzer
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA.
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Ducroq J, Rouet R, Sallé L, Puddu PE, Repessé Y, Ghadanfar M, Ducouret P, Gérard JL. Class III effects of dofetilide and arrhythmias are modulated by [K+]o in an in vitro model of simulated-ischemia and reperfusion in guinea-pig ventricular myocardium. Eur J Pharmacol 2006; 532:279-89. [PMID: 16480976 DOI: 10.1016/j.ejphar.2005.12.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 12/18/2005] [Accepted: 12/22/2005] [Indexed: 10/25/2022]
Abstract
To evaluate class III effects of clinically relevant concentrations of dofetilide (5 and 10 nmol/l) and the effects of extracellular potassium [K+]o modulation of arrhythmias onset at the level of the "border zone," we used a previously reported in vitro model whereby normoxic and ischemic/reperfused zones were studied. Guinea-pig right ventricular strips (driven at 1 Hz at 36.5+/-0.5 degrees C) were superfused with Tyrode's solution in oxygenated (HCO3- 25 mmol/l, K+ 4 mmol/l, pH 7.35+/-0.05, glucose 5.5 mmol/l: normal zone) and ischemia-simulating conditions (HCO3- 9 mmol/l, pH 6.90+/-0.05, no oxygen and no glucose: altered zone) having either [K+]o 4 (n=20), 8 (n=20) or 12 (n=20) mmol/l. Action potentials in normal and altered zones were recorded simultaneously during 30 min of simulated-ischemia and after 30 min of reperfusion with oxygenated Tyrode's solution. Each preparation served as control for successive phases of dofetilide studies (at 5 and 10 nmol/l) and action potential values were normalized to those present at the beginning of the experiment. During simulated-ischemia, the higher the [K+]o the worse were action potential changes, although full recovery was seen upon 30 min of reperfusion in all [K+]o groups. A high incidence of ischemia/reperfusion arrhythmias was observed in 4 and 12 mmol/l [K+]o groups as opposed to a low incidence of arrhythmias in 8 mmol/l [K+]o group. Dofetilide at 5 and 10 nmol/l with all [K+]o explored: (i) exhibited class III effects, (ii) was effective (or neutral) against ventricular arrhythmias during both simulated-ischemia and reperfusion, and (iii) did not globally increase the dispersion of action potential durations between normal and altered zones. Different arrhythmogenic mechanisms are involved in this model at different [K+]o with 8 mmol/l providing relative protection. Class III effects of dofetilide are evident in the normal zone when in the ischemic-like zone [K+]o ranges from 4 to 12 mmol/l. Thus dofetilide did not increase dispersion of repolarization and had either an antiarrhythmic or a neutral effect during ischemia/reperfusion.
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Affiliation(s)
- Joffrey Ducroq
- Laboratoire d'Anesthésiologie Expérimentale et de Physiologie Cellulaire E3212, University of Caen, France
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Qin H, Huang J, Rogers JM, Walcott GP, Rollins DL, Smith WM, Ideker RE. Mechanisms for the Maintenance of Ventricular Fibrillation: The Nonuniform Dispersion of Refractoriness, Restitution Properties, or Anatomic Heterogeneities? J Cardiovasc Electrophysiol 2005; 16:888-97. [PMID: 16101633 DOI: 10.1111/j.1540-8167.2005.40650.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The relative importance of nonuniform dispersion of refractoriness, steep restitution slopes, and anatomic heterogeneities in causing conduction block during ventricular fibrillation (VF) remains unknown. METHODS AND RESULTS In six open-chest pigs, ventricular refractoriness and restitution curves were estimated from activation recovery intervals (ARIs) calculated from 504 (21 x 24) unipolar electrode recordings 2 mm apart in a plaque sutured to the left ventricular (LV) free wall. A steady-state restitution protocol was performed twice at each of two pacing sites: the LV base and near the left anterior descending artery. VF was electrically induced four times and the incidence of conduction block at each electrode during the first 20 seconds was determined by an automated algorithm. The gradient of the ARI was calculated at each electrode to estimate the spatial dispersion of refractoriness. An exponential curve was fit to the restitution plots of ARIs versus the corresponding diastolic intervals (DIs) for all pacing cycle lengths at each electrode. The locations of epicardial blood vessels were noted after the study. Spatial patterns of conduction block were significantly correlated between the four VF episodes in the same animal (r = 0.66 +/- 0.07, P < 0.05). At the shortest pacing cycle length, the spatial distribution of ARIs, ARI gradients, and restitution slopes was not random but formed clusters of similar values. However, none of these variables was significantly correlated with the incidence of conduction block, even though ARI gradients >2 msec/mm were present between many clusters and approximately 90% of restitution slopes were >1. Instead, conduction block frequently appeared to cluster along epicardial vessels. CONCLUSION Neither the dispersion of refractoriness nor action potential duration restitution determined during rapid pacing by itself is the major determinant of the location of conduction block during early VF in normal pigs. It may be that these factors interact synergistically with each other as well as with other factors, including anatomic heterogeneities such as those caused by blood vessels, which may be particularly important for the formation of conduction block and maintenance of VF.
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Affiliation(s)
- Hao Qin
- Department of Medicine, University of Alabama, Birmingham, Alabama 35294, USA
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Xing D, Martins JB. Triggered activity due to delayed afterdepolarizations in sites of focal origin of ischemic ventricular tachycardia. Am J Physiol Heart Circ Physiol 2004; 287:H2078-84. [PMID: 15475531 DOI: 10.1152/ajpheart.00027.2004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study for the first time systematically evaluated the site of origin of focal ventricular tachycardia (VT) induced 1–3 h after acute coronary artery ligation in dogs. We determined whether delayed afterdepolarizations (DADs) and triggered activity (TA) are more often recorded from ischemic endocardium excised from focal sites of VT origin. A total of 145 α-chloralose-anesthetized dogs were studied: in 54 dogs without inducible VT, normal or ischemic endocardium was investigated in vitro; in 91 dogs, inducible VT was studied by three-dimensional activation mapping, with in vitro study of 51 endocardial foci compared with 40 endocardial ischemic sites not of VT origin. Incidence of DADs (71% vs. 33%, P < 0.05) and TA (32% vs. 11%, P < 0.05) was greater in ischemic than in normal Purkinje tissues. Purkinje sites of origin of focal VT demonstrated the greatest frequency of DADs (92%, P < 0.05) and TA (75%, P < 0.05), with repetitive TA predominating. Similar results were obtained in endocardial sites of origin. Action potentials were mildly depolarized and prolonged in the focal sites of origin. These abnormalities were stable up to 2.5 h of recording. This study demonstrated that DADs and TA may underlie a majority of focal VTs in ischemic endocardium and Purkinje tissue.
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Affiliation(s)
- Dezhi Xing
- Div. of Cardiovascular Diseases, Dept. of Internal Medicine, Univ. of Iowa College of Medicine, 200 Hawkins Dr., E318-3 GH, Iowa City, IA 52242, USA
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Abstract
Propagation of excitation in the heart involves action potential (AP) generation by cardiac cells and its propagation in the multicellular tissue. AP conduction is the outcome of complex interactions between cellular electrical activity, electrical cell-to-cell communication, and the cardiac tissue structure. As shown in this review, strong interactions occur among these determinants of electrical impulse propagation. A special form of conduction that underlies many cardiac arrhythmias involves circulating excitation. In this situation, the curvature of the propagating excitation wavefront and the interaction of the wavefront with the repolarization tail of the preceding wave are additional important determinants of impulse propagation. This review attempts to synthesize results from computer simulations and experimental preparations to define mechanisms and biophysical principles that govern normal and abnormal conduction in the heart.
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Affiliation(s)
- André G Kléber
- Department of Physiology, University of Bern, Bühlplatz 5, CH-3012 Bern, Switzerland.
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Huelsing DJ, Spitzer KW, Cordeiro JM, Pollard AE. Conduction between isolated rabbit Purkinje and ventricular myocytes coupled by a variable resistance. THE AMERICAN JOURNAL OF PHYSIOLOGY 1998; 274:H1163-73. [PMID: 9575919 DOI: 10.1152/ajpheart.1998.274.4.h1163] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Conduction at the Purkinje-ventricular junction (PVJ) demonstrates unidirectional block under both physiological and pathophysiological conditions. Although this block is typically attributed to multidimensional electrotonic interactions, we examined possible membrane-level contributions using single, isolated rabbit Purkinje (P) and ventricular (V) myocytes coupled by an electronic circuit. When we varied the junctional resistance (Rj) between paired V myocytes, conduction block occurred at lower Rj values during conduction from the smaller to larger myocyte (115 +/- 59 M omega) than from the larger to smaller myocyte (201 +/- 51 M omega). In Purkinje-ventricular myocyte pairs, however, block occurred at lower Rj values during P-to-V conduction (85 +/- 39 M omega) than during V-to-P conduction (912 +/- 175 M omega), although there was little difference in the mean cell size. Companion computer simulations, performed to examine how the early platea currents affected conduction, showed that P-to-V block occurred at lower Rj values when the transient outward current was increased or the calcium current was decreased in the model P cell. These results suggest that intrinsic differences in phase 1 repolarization can contribute to unidirectional block at the PVJ.
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Affiliation(s)
- D J Huelsing
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana 70125, USA
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Gilmour RF, Watanabe M. Dynamics of circus movement re-entry across canine Purkinje fibre-muscle junctions. J Physiol 1994; 476:473-85. [PMID: 8057255 PMCID: PMC1160461 DOI: 10.1113/jphysiol.1994.sp020148] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
1. To determine the cellular electrophysiological mechanisms for unidirectional conduction block and re-entrant excitation, single cycles of circus movement re-entry were induced in canine Purkinje fibre-papillary muscle preparations containing two Purkinje fibre-muscle junctions (PMJs). The preparations were mounted in a partitioned tissue bath that permitted independent superfusion of each PMJ. The pre-existing dispersion of refractoriness between PMJs was accentuated by superfusing PMJ1 with normal Tyrode solution or Tyrode solution containing 6-8 mM KCl and superfusing PMJ2 with Tyrode solution containing 0.5 mM heptanol and 4-10 mM KCl. 2. Premature stimuli delivered to the Purkinje fibre induced unidirectional anterograde conduction block at PMJ2. Conduction proceeded from Purkinje cells to papillary muscle at PMJ1 and from papillary muscle retrogradely across the previously blocked PMJ2. 3. The difference in refractory periods between the two PMJs defined a range of premature coupling intervals within which re-entry was inducible. Conduction block at the PMJ occurred in papillary muscle at short coupling intervals and in the Purkinje fibre at longer intervals. 4. Once initiated, re-entry could be reset or annihilated by properly timed subthreshold current pulses delivered to cells at the PMJ. 5. To define better the mechanisms for conduction block and re-entry, an analytical model was developed using non-linear regression analysis to derive equations from the experimental results. Varying parameters within the constraints of the model reproduced the key features of the rate-dependent conduction block observed experimentally. Critical elements of the model included the induction of significant activation delays at short diastolic intervals and a reduction in the rate of action potential duration restitution after exposure to heptanol. 6. These results help to establish the conditions necessary for induction of one-dimensional circus movement re-entry and to define the roles of non-linearities of activation delay and excitability in the dynamics of conduction block at the PMJ.
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Affiliation(s)
- R F Gilmour
- Department of Physiology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401
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Bélichard P, Pruneau D, Salzmann JL, Rouet R. Decreased susceptibility to arrhythmias in hypertrophied hearts of physically trained rats. Basic Res Cardiol 1992; 87:344-55. [PMID: 1417704 DOI: 10.1007/bf00796520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aim of this study was to investigate the propensity to develop cardiac arrhythmias during an acute period of ischemia between normal and hypertrophied (by means of a swimming training regimen) rat hearts. We used the coronary artery ligation in vivo technique which induced the occurrence of cardiac arrhythmias in rats that was followed by the determination of the occluded zone size. This study was coupled to an in vitro study using a two-compartment tissue bath in which half of the ventricular preparation was exposed to normal conditions and the other to ischemic conditions (low pH, hypoxia, and hyperkalemia). We also measured the collagen content and the DNA/protein ratio of the hearts. Twenty-eight male Wistar rats submitted to an eight-week swimming training (SWT) and twenty-eight cage-confined matched rats were used for the studies. SWT resulted in a 14% decrease in mean body weight and an 8% increase in absolute heart weight. We also observed a resting bradycardia in the trained animals and blood pressure remained unchanged between the two groups. Collagen content was unchanged and DNA/protein ratio was lower in the left ventricle of trained animals. During a 30-min period of coronary artery ligation, SWT rats demonstrated fewer ischemia-induced arrhythmias as compared to controls. The size of the zone affected by the vasal occlusion was lower in trained animals. Electrophysiological data recorded in the two-compartment bath showed a marked prolongation of action potential duration and refractory period in the SWT rat hearts. During the 15-min period of in vitro ischemia there was a global alteration of all electrophysiological parameters which did not differ between the two groups. Our data support the hypothesis that resting bradycardia and decrease in ischemic zone size may be involved in the arrhythmogenic protection observed in hypertrophied hearts of swimming rats after an acute ligation of the left coronary artery. Our results also indicate that cardiac hypertrophy, as defined by quantitative changes in cardiac mass or by the electrophysiological alterations that are related to its development, is not necessarily associated with an increased risk for the occurrence of arrhythmias.
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Affiliation(s)
- P Bélichard
- Centre de recherche des laboratoires Fournier, Daix, France
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Affiliation(s)
- R W Joyner
- Department of Pediatrics, Emory University, Atlanta, Georgia 30323
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