Cardiac potassium currents and channels. Part II: Implications for clinical practice and therapy

Effects of taurine-magnesium coordination compound on ionic channels in rat ventricular myocytes of arrhythmia induced by ouabain

Taurine-magnesium coordination compound (TMCC) has anti-arrhythmic effects. The aim of the present study was to explore the targets of the anti-arrhythmic effect of TMCC and the electrophysiological effects of TMCC on ouabain-induced arrhythmias in rat ventricular myocytes. Sodium current (I(Na)), L-type calcium current (I(ca, L)), and transient outward potassium current (I(to)) were measured and analyzed using whole-cell patch-clamp recording technique in normal rat cardiac myocytes and rat ventricular myocytes of arrhythmia induced by ouabain. In isolated ventricular myocytes, I(Na) and I(to) were blocked by TMCC (100, 200, 400 μM) in a concentration-dependent manner, and the effects of TMCC (400 μM) were equal to that of amiodarone. However, I (ca, L) was moderately increased by TMCC (400 μM) while significantly decreased by amiodarone. Ouabain (5 μM) significantly decreased sodium, L-type calcium, and transient outward potassium currents. TMCC (100 μM) relieved abnormal sodium currents induced by ouabain through facilitation of steady-state inactivation. TMCC (200 and 400 μM) relieved abnormal L-type calcium currents induced by ouabain through facilitation of steady-state activation and retardation of steady-state inactivation. TMCC failed to further inhibit abnormal transient outward potassium currents induced by ouabain. However, amiodarone inhibited the decreasing sodium, L-type calcium, and transient outward potassium currents further. These data suggest that I(Na), I(ca, L), and I(to) may be the targets of the antiarrhythmic effect of TMCC, which can antagonize ouabain-induced changes of ionic currents in rat ventricular myocytes.

Effects of anandamide on potassium channels in rat ventricular myocytes: a suppression of Ito and augmentation of KATP channels

Anandamide is an endocannabinoid that has antiarrhythmic effects through inhibition of L-type Ca2+ channels in cardiomyocytes. In this study, we investigated the electrophysiological effects of anandamide on K+ channels in rat ventricular myocytes. Whole cell patch-clamp technique was used to record K+ currents, including transient outward potassium current ( Ito), steady-state outward potassium current ( Iss), inward rectifier potassium current ( IK1), and ATP-sensitive potassium current ( IKATP) in isolated rat cardiac ventricular myocytes. Anandamide decreased Ito while increasing IKATP in a concentration-dependent manner but had no effect on Iss and IK1 in isolated ventricular myocytes. Furthermore, anandamide shifted steady-state inactivation curve of Ito to the left and shifted the recovery curve of Ito to the right. However, neither cannabinoid 1 (CB1) receptor antagonist AM251 nor CB2 receptor antagonist AM630 eliminated the inhibitory effect of anandamide on Ito. In addition, blockade of CB2 receptors, but not CB1 receptors, eliminated the augmentation effect of anandamide on IKATP. These data suggest that anandamide suppresses Ito through a non-CB1 and non-CB2 receptor-mediated pathway while augmenting IKATP through CB2 receptors in ventricular myocytes.

Arrhythmogenic mechanisms of non-sedating antihistamines

Antihistamines (H1-receptor antagonists) are amongst the most frequently prescribed drugs worldwide for the treatment of allergic conditions. Recently, there have been reports that certain non-sedating antihistamines, mainly terfenadine and astemizole, might be associated with the risk of rare but severe arrhythmias, namely torsades de pointes, particularly in overdosage, concomitant ingestion of imidazole or macrolide antibiotics and in patients with underlying cardiac or liver diseases. It has now been shown that the molecular target in human ventricle for the potassium channel blockade of antihistamine is HERG gene located in chromosome 7 that expresses the delayed rectifier IKr and appears to be involved in the congenital long QT syndrome. Mechanistic studies showed that blockade of IKr channels by these drugs leads to prolongation of the monophasic action potential (QT interval on surface electrocardiogram) which may then induce the development of early after-depolarization and dispersion of repolarisation leading to torsades de pointes through re-entry mechanism. There are still many questions that need to be answered such as the roles of other potassium channels (IKs, Ito, and Iped) and the relative expression of various potassium channels in different individuals which may be important in the pathogenesis of torsades de pointes with non-sedating antihistamines. There is also a lack of information on the cardiac actions of newer non-sedating antihistamines. It is hoped that with a better understanding of the arrhythmogenic mechanism of non-sedating antihistamines, one will be able to identify those at risk patients and prevent any cardiac toxicity associated with antihistamines and ultimately death.