Formation of a border ischemic zone depends on plasma potassium concentration

Extracellular potassium concentration might modify electrophysiological properties in the border zone of ischemic myocardium. We evaluated the depolarization and repolarization characteristics across the ischemic-normal border under [K+] variation. Sixty-four-lead epicardial mapping was performed in 26 rats ([K+] 2.3-6.4 mM) in a model of acute ischemia/reperfusion. The animals with [K+] < 4.7 mM (low-normal potassium) had an ischemic zone with ST-segment elevation and activation delay, a border zone with ST-segment elevation and no activation delay, and a normal zone without electrophysiological abnormalities. The animals with [K+] >4.7 mM (normal-high potassium) had only the ischemic and normal zones and no transitional area. Activation-repolarization intervals and local conduction velocities were inversely associated with [K+] in linear regression analysis with adjustment for the zone of myocardium. The reperfusion extrasystolic burden (ESB) was greater in the low-normal as compared to normal-high potassium animals. Ventricular tachycardia/fibrillation incidence did not differ between the groups. In patch-clamp experiments, hypoxia shortened action potential duration at 5.4 mM but not at 1.3 mM of [K+]. IK(ATP) current was lower at 1.3 mM than at 5.4 mM of [K+]. We conclude that the border zone formation in low-normal [K+] was associated with attenuation of IK(ATP) response to hypoxia and increased reperfusion ESB.

Melatonin receptor blockade slows ventricular conduction by IK1 downregulation

Background

Melatonin has been reported to prevent life-threatening arrhythmias in myocardial ischemia and reperfusion. The recent study from our group demonstrated that the antiarrhythmic action of melatonin was associated with enhanced recovery of resting membrane potential (RMP) and shortened activation time delay in the affected myocardium. This effect was independent of melatonin antioxidative properties, which raises a question about the involvement of melatonin receptor-dependent signaling in the electrophysiological action of melatonin. The aim of this study was to evaluate a role of MT1/MT2 melatonin receptors in the regulation of RMP and ventricular conduction velocity (CV).

Methods

Anesthetized male rats underwent coronary occlusion (5 min) and reperfusion (5 min). 5 min before ischemia induction the animals were intravenously injected with saline (control, n=7), melatonin (4 mg/kg, n=8), luzindole (MT1/MT2 receptor blocker, 0.4 mg/kg, n=6), and melatonin/luzindole combination (4 and 0.4 mg/kg, respectively, n=7). CV was measured in baseline and reperfusion by epicardial 64-lead mapping under epicardial pacing. In the enzymatically isolated ventricular myocytes (n=20 cells), voltage- and current-clamp modes of whole cell patch-clamp were used for measurements of IK1 and INa currents, and RMP, respectively. Melatonin (10 uM), luzindole (1 uM) and their combination were added to the bath solution.

Results

Luzindole application decreased baseline longitudinal CV as compared to placebo (52±3 vs 42±2 cm/s, p=0.028, respectively). Paired comparisons demonstrated that longitudinal CV decreased at reperfusion vs baseline in the control group (35±2 vs 53±6 cm/s, p=0.018) and in the luzindole group (33±4 vs 38±3 cm/s, p=0.039), whereas no significant differences were observed in the melatonin and melatonin/luzindole groups (40±5 vs 51±3 cm/s, p=0.114 and 39±3 vs 43±3 cm/s, p=0.498, respectively). Neither melatonin nor luzindole changed INa current characteristics (Figure, panels a and b). The average amplitude of IK1 current was 2.08±0.92 at −50 mV and −16.11±4.70 pA/pF at −120 mV in the normal Tyrode solution. Luzindole significantly reduced IK1 amplitude to 0.82±0.48 (p=0.028) and −5.6±1.6 (p=0.008) pA/pF at −50 and −120 mV, respectively. Addition of melatonin to the luzindole-containing solution partly abolished the luzindole effect (Figure, panel c). Luzindole also reduced RMP from −63±10 mV to −37±12 mV (p=0.013) and caused an increase in APD100 duration from 35±6 ms to 170±43 ms (p=0.003) (Figure, panel d).

Conclusion

Thus, MT1/MT2 receptor block with luzindole did not affect INa but led to the down-regulation of IK1 and depolarization of RMP. These effects can reduce accessibility of sodium channels and be the basis for the observed luzindole-dependent CV slowing. The obtained data support the significance of melatonin receptor-dependent signaling in the realization of antiarrhythmic effects of melatonin.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation

Prolongation of experimental diabetes mellitus increased susceptibility to reperfusion ventricular tachyarrhythmias

Diabetes mellitus (DM) is associated with increased risk of sudden cardiac death, but its role in arrhythmogenesis is not clear. We evaluated contributions of DM duration and hyperglycemia level to development of proarrhythmic electrophysiological changes in the experimental ischemia/reperfusion model. Ventricular epicardial 64-lead mapping and arrhythmia susceptibility burst-pacing testing were performed in 43 healthy and 55 diabetic (alloxan model) anesthetized rabbits undergoing 15 min left anterior descending coronary artery occlusion, followed by 15 min reperfusion. During ischemia, arrhythmia inducibility did not differ between the groups, but the number of reperfusion ventricular tachycardias and (or) fibrillations (VT/VFs) were higher in the DM group (14 out of 55) as compared with control (3 out of 43, p = 0.017). In the diabetic animals, both DM duration and glucose concentration were associated with reperfusion VT/VF development in univariate logistic regression analysis (odds ratio (OR) 1.058, 95% confidence interval (CI) 1.025-1.092, p < 0.001; and OR 1.119, 95% CI 1.045-1.198, p = 0.001, respectively). Only the DM duration, however, remained an independent predictor of reperfusion VT/VF in multivariate logistic regression analysis (OR 1.060, 95% CI 1.006-1.117, p = 0.029). Among mapping parameters, DM duration was associated with the prolongation of total ventricular activation duration (regression coefficient 0.152, 95% CI 0.049-0.255, p = 0.005) and activation-repolarization intervals (ARIs) (regression coefficient 0.900, 95% CI 0.315-1.484, p = 0.003). The prolonged ARI was the only mapping characteristic predicting reperfusion VT/VF development (OR 1.028, 95% CI 1.009-1.048, p = 0.004). The DM duration-dependent prolongation of ventricular repolarization presents a link between DM development and reperfusion VT/VF inducibility.

Effect of the left ventricular overload on epicardial repolarization in the rabbit

OBJECTIVE

We have investigated the local durations and sequence of repolarization in the ventricular epicardium in the rabbit under the increase of the left ventricular (LV) afterload.

METHODS

The LV overload was produced by the 1-minute aortic stenosis up to systolic blood pressure of 140 mm Hg. The experiments were carried out on eight anaesthetized rabbits (urethane, 1.5 g/kg, ip). Unipolar electrograms were simultaneously recorded from 64 ventricular epicardial leads at 33 degrees C.

RESULTS

At baseline state, the shortest activation-recovery intervals (ARIs) were observed in the right ventricular (RV) base, the longest ARIs in the LV apex and lateral wall, and ARIs of intermediate durations in the RV apex and LV base. According to ARI distribution, a significant gradient in repolarization times was observed between the apex and base (p<0.01). Under acute LV overload, the repolarization duration increased significantly (p<0.01) locally at the LV apex and adjacent area of the free wall. Dispersion of repolarization is increased in the apex. A decrease of ARIs (p<0.05) was observed at the RV base, as well.

CONCLUSION

Under acute increase in the LV afterload, ventricular epicardial activation sequence remained largely unaltered which, along with changes in local repolarization durations, resulted in the repolarization sequence being quite similar to the baseline one. The earliest repolarization occurred in posterobasal region of RV whereas the areas over the LV apex and adjacent area of the free wall were the last to repolarize.