Background-The short-QT syndrome is a new clinical entity characterized by corrected QT intervals Ͻ300 ms and a high incidence of ventricular tachycardia (VT) and fibrillation (VF). Gain-of-function mutations in the gene for outward potassium currents have been shown to underlie the congenital syndrome. The present study examined the cellular basis of VT/VF in an experimental model associated with short QT intervals created with a potassium channel activator. Methods and Results-Transmembrane action potentials from epicardial and M regions, 4 transmural unipolar electrograms, and a pseudo-ECG were simultaneously recorded in canine arterially perfused left ventricular wedge preparations. At a basic cycle length of 2000 ms, pinacidil (2 to 3 mol/L) abbreviated the QT interval from 303.7Ϯ5.4 to 247.3Ϯ6.9 ms (meanϮSEM, PϽ0.0001). The maximal transmural dispersion of repolarization (TDR max ) increased from 27.0Ϯ3.8 to 64.9Ϯ9.2 ms (PϽ0.01), and an S2 applied to the endocardium induced a polymorphic VT (pVT) in 9 of 12 wedge preparations (PϽ0.01). Addition of isoproterenol (100 nmol/L, nϭ5) led to greater abbreviation of the QT interval, a further increase in TDR max (from 55.4Ϯ13.7 to 69.7Ϯ8.3 ms), and more enduring pVT. TDR max was correlated significantly with the T peak -T end interval under all conditions. The effects of pinacidil were completely reversed by glybenclamide (10 mol/L, nϭ4) and partially reversed by E4031 (5 mol/L, nϭ5), which prevented induction of pVT in 3 of 5 preparations.
Conclusions-Our