Key points• Cardiac repolarization, through which heart-cells return to their resting state after having fired, is a delicate process, susceptible to disruption by common drugs and clinical conditions. • Animal models, particularly the dog, are often used to study repolarization properties and responses to drugs, with the assumption that such findings are relevant to humans. However, little is known about the applicability of findings in animals to man.• Here, we studied the contribution of various ion-currents to cardiac repolarization in canine and human ventricle.• Humans showed much greater repolarization-impairing effects of drugs blocking the rapid delayed-rectifier current I Kr than dogs, because of lower repolarization-reserve contributions from two other important repolarizing currents (the inward-rectifier I K1 and slow delayed-rectifier I Ks ).• Our findings clarify differences in cardiac repolarization-processes among species, highlighting the importance of caution when extrapolating results from animal models to man.Abstract The species-specific determinants of repolarization are poorly understood. This study compared the contribution of various currents to cardiac repolarization in canine and human ventricle. Conventional microelectrode, whole-cell patch-clamp, molecular biological and mathematical modelling techniques were used. Selective I Kr block (50-100 nmol l −1 dofetilide) lengthened AP duration at 90% of repolarization (APD 90 ) >3-fold more in human than dog, suggesting smaller repolarization reserve in humans. Selective I K1 block (10 μmol l −1 BaCl 2 ) and I Ks block (1 μmol l −1 HMR-1556) increased APD 90 more in canine than human right ventricular papillary muscle. Ion current measurements in isolated cardiomyocytes showed that I K1 and I Ks densities were 3-and 4.5-fold larger in dogs than humans, respectively. I Kr density and kinetics were similar in human versus dog. I Ca and I to were respectively ∼30% larger and ∼29% smaller in human, and Na + -Ca 2+ exchange current was comparable. Cardiac mRNA levels for the main I K1 ion channel subunit Kir2.1 and the I Ks accessory subunit minK were significantly lower, but mRNA expression of ERG and KvLQT1 (I Kr and I Ks α-subunits) were not significantly different, in human versus dog. Immunostaining suggested lower Kir2.1 and minK, and higher KvLQT1 protein expression in human versus canine cardiomyocytes. I K1 and I Ks inhibition increased the APD-prolonging effect of I Kr block more in dog (by 56% and 49%, respectively) than human (34 and 16%), indicating that both currents contribute to increased repolarization reserve in the dog. A mathematical model incorporating observed human-canine ion current differences confirmed the role of I K1 and I Ks in repolarization reserve differences. Thus, humans show greater repolarization-delaying effects of I Kr block than dogs, because of lower repolarization reserve contributions from I K1 and I Ks , emphasizing species-specific determinants of repolarization and the limitations of animal models fo...

Enhanced temporal and spatial variability in cardiac repolarization has been related to increased arrhythmic risk both clinically and experimentally. Causes and modulators of variability in repolarization and their implications in arrhythmogenesis are however not well understood. At the ionic level, the slow component of the delayed rectifier potassium current (I(Ks)) is an important determinant of ventricular repolarization. In this study, a combination of experimental and computational multiscale studies is used to investigate the role of intrinsic and extrinsic noise in I(Ks) in modulating temporal and spatial variability in ventricular repolarization in human and guinea pig. Results show that under physiological conditions: i), stochastic fluctuations in I(Ks) gating properties (i.e., intrinsic noise) cause significant beat-to-beat variability in action potential duration (APD) in isolated cells, whereas cell-to-cell differences in channel numbers (i.e., extrinsic noise) also contribute to cell-to-cell APD differences; ii), in tissue, electrotonic interactions mask the effect of I(Ks) noise, resulting in a significant decrease in APD temporal and spatial variability compared to isolated cells. Pathological conditions resulting in gap junctional uncoupling or a decrease in repolarization reserve uncover the manifestation of I(Ks) noise at cellular and tissue level, resulting in enhanced ventricular variability and abnormalities in repolarization such as afterdepolarizations and alternans.

Background Early repolarization pattern in the ECG has been associated with increased risk for ventricular tachycardia/fibrillation (VT/VF), particularly when manifest in inferior leads. This study examines the mechanisms underlying VT/VF in the early repolarization syndrome (ERS). Method Transmembrane action potentials (AP) were simultaneously recorded from 2 epicardial and 1 endocardial site of coronary-perfused canine left-ventricular (LV) wedge preparations, together with a pseudo-ECG. Transient outward current (Ito) was recorded from epicardial myocytes isolated from inferior and lateral LV of the same heart. Results J wave area (pseudo-ECG), epicardial AP notch magnitude and index were larger in inferior vs. lateral wall preparations at baseline and after exposure to provocative agents (NS5806+verapamil+acetylcholine (ACh)). Ito density was greater in myocytes from inferior vs. lateral wall (18.4±2.3pA/pF vs. 11.6±2.0pA/pF;p<0.05). A combination of NS5806 (7μM) and verapamil (3μM) or pinacidil (4μM), used to pharmacologically model the genetic defects responsible for ERS, resulted in prominent J-point and ST-segment elevation. ACh (3μM), simulating increased vagal tone, precipitated phase-2-reentry-induced polymorphic VT/VF. Using identical protocols, inducibility of arrhythmias was 3-fold higher in inferior vs. lateral wedges. Quinidine (10μM) or isoproterenol (1μM) restored homogeneity and suppressed VT/VF. Conclusion Our data support the hypothesis that 1) ERS is caused by a preferential accentuation of the AP notch in LV epicardium; 2) this repolarization defect is accentuated by elevated vagal tone; 3) higher intrinsic levels of Ito account for the greater sensitivity of the inferior LV wall to development of VT/VF; 4) quinidine and isoproterenol exert ameliorative effects by reversing the repolarization abnormality.

Objectives To test the hypothesis that late potentials and fractionated electrogram activity are due to delayed depolarization within the anterior aspects of right ventricular (RV) epicardium in experimental models of Brugada syndrome (BrS). Background Clinical reports have demonstrated late potentials in SAECG recorded in patients with BrS. Recent studies report the appearance of late potentials and fractionated activity in bipolar electrograms recorded from the epicardium of the RV outflow tract in patients with BrS. Methods Action potential (AP) and bipolar electrograms were recorded from epicardial and endocardial sites of coronary-perfused canine RV wedge preparations together with a pseudo-electrocardiogram (ECG). The Ito agonist NS5806 (5 μM) and Ca2+ channel blocker verapamil (2 μM) were used to pharmacologically mimic BrS genotypes. Results Fractionated electrical activity was observed in RV epicardium but not endocardium as a consequence of heterogeneities in the appearance of the second upstroke of the epicardial AP and discrete high frequency spikes developed as a result of concealed phase-2-reentry. In no case did we observe primary conduction delay as the cause of the BrS ECG phenotype or of late potential or fractionated electrogram activity. Quinidine (10 μM) or phosphodiestaerase-3-inhibitors milrinone (2.5 μM) and cilostazol (10 μM) restored electrical homogeneity, thus abolishing all late potential and fractionated electrical activity. Conclusions Our data point to an alternative pathophysiological basis for late potentials and fractionated electrograms recorded from the RV in the setting of BrS. We demonstrate association of such activity with abnormal repolarization and not with abnormal depolarization or structural abnormalities.