Background
Frequent premature ventricular contractions (PVCs) are associated with increased risk for sudden cardiac death (SCD) and can cause secondary cardiomyopathy (CM).
Objective
We sought to determine the mechanism(s) responsible for prolonged refractory period and LV dysfunction demonstrated in our canine model of PVC-induced CM.
Methods
Single myocytes were isolated from LV free wall of PVC and control canines, and used for patch clamp recording, [Ca]i measurements and immunocytochemistry/confocal microscopy. LV tissues adjacent to area of myocyte isolation were used for immunoblot quantification of protein expression.
Results
In PVC group, LVEF declined from 57.6±1.5% to 30.4±3.1% after ≥ 4 months of ventricular bigeminy. Compared to control myocytes, PVC myocytes had reduced densities of both outward (Ito and IK1) and inward (ICaL) currents, but no consistent changes in IKr or IKs. The reduction in Ito, IK1 and ICaL was accompanied by decreased protein levels of their channel subunits. The degrees of reduction in Ito, IK1 and ICaL varied among PVC myocytes, creating marked heterogeneity in action potential (AP) configurations and durations. PVC myocytes showed impaired Ca-induced Ca release from SR, without increase in SR Ca leak or decrease in SR Ca store. This was accompanied by a decrease in dyad scaffolding protein, junctophilin-2, and loss of Cav1.2 registry with Ca-releasing channels (RyR2).
Conclusion
PVCs increase dispersion of AP configuration/duration, a risk factor for SCD, due to heterogeneous reduction in Ito, IK1 and ICaL. The E-C coupling is impaired due to decrease in ICaL and Cav1.2 misalignment with respect to RyR2.