We have previously shown that targeted disruption of the mouse Kcnq1 gene produces a long QT phenotype in vivo that requires extracardiac factors for manifestation (Casimiro et al., 2001). In the present study, we explore the hypothesis that autonomic neuroeffector transmission represents the "extracardiac" stimulus that induces a long QT phenotype in mouse hearts lacking Kcnq1. Using the isolated perfused (Langendorff) mouse heart preparation, we challenged wild-type (Kcnq1 ϩ/ϩ ) and mutant (Kcnq1 Ϫ/Ϫ ) mouse hearts with nicotine, an autonomic stimulant. ECGs were recorded continuously, and QT intervals were compared at baseline and peak nicotineinduced heart rates. No significant differences in QT or any other ECG parameters were observed in Kcnq1 ϩ/ϩ versus Kcnq1 Ϫ/Ϫ hearts at baseline. In the presence of nicotine, however, the JT, QT, and rate-corrected QT (QTc) intervals were significantly prolonged in Kcnq1 Ϫ/Ϫ hearts relative to Kcnq1