2ϩ transients in initiation of apoptotic processes in this cell type. Simultaneously with the beating, these cells show dynamic structural alteration resulting from cytoskeletal disintegration that is quite rapid. Because of the specialized structure and extensive cytoskeleton of cardiomyocytes, we hypothesized that its degradation in so short a time would require a particularly efficient mechanism. To better understand this mechanism, we used serial video microscopy to observe -adrenergic stimulation-induced apoptosis in isolated adult rat cardiomyocytes while simultaneously recording intracellular Ca 2ϩ concentration and cell length. Trains of Ca 2ϩ transients and corresponding rhythmic contractions and relaxations (beating) were observed in apoptotic cells. Frequencies of Ca 2ϩ transients and beating gradually increased with time and were accompanied by cellular shrinkage. As the cells shrank, amplitudes of Ca 2ϩ transients declined and diastolic intracellular Ca 2ϩ concentration increased until the transients were lost. Beating and progression of apoptosis were significantly inhibited by antagonists against the L-type Ca 2ϩ channel (nifedipine), ryanodine receptor (ryanodine), inositol 1,4,5-trisphosphate receptor (heparin), sarco(endo)plasmic Ca 2ϩ -ATPase (thapsigargin), and Na ϩ /Ca 2ϩ exchanger (KB-R7943). Electron-microscopic examination of beating cardiomyocytes revealed progressive breakdown of Z disks. Immunohistochemical analysis and Western blot confirmed that disappearance of Z disk constituent proteins (␣-actinin, desmin, and tropomyosin) preceded degradation of other cytoskeletal proteins. It thus appears that, in adult cardiomyocyte apoptosis, Ca 2ϩ transients mediate apoptotic beating and efficient sarcomere destruction initiated by Z disk breakdown. apoptosis; calcium regulation; cardiac myocytes; sarcomere; Z disk SEVERAL REPORTS have suggested that apoptosis among cardiomyocytes plays an important role in the progression of cardiovascular disease (1,7,11). This idea remains controversial, however, because the ultrastructural changes characteristic of apoptosis have only rarely been seen in cardiomyocytes from diseased hearts (8,16,34). However, cardiomyocyte apoptosis can be induced in vitro by a variety of stimuli. For instance, we and others previously described Fas-induced, hypoxia-induced, and -adrenergic pathway-stimulated apoptosis in cultured adult cardiomyocytes (5,15,17,22).Adult cardiomyocytes are terminally differentiated cells that are highly specialized in terms of structure and function. They express contractile proteins and a particularly well-developed cytoskeleton that are tightly packed into the cytoplasm and are sensitive to the Ca 2ϩ load, mediating continual contraction and relaxation in vivo. In an earlier study, we used serial video and electron microscopy to show several unique features of apoptosis in adult cardiomyocytes, including the rhythmic contraction and relaxation (beating) that precede cellular deformation, accelerate as the cell shrinks, and are accompan...