Palytoxin is a coral toxin that seriously impairs heart function, but its effects on excitation-contraction (E-C) coupling have remained elusive. Therefore, we studied the effects of palytoxin on mechanisms involved in atrial E-C coupling. In field-stimulated cat atrial myocytes, palytoxin caused elevation of diastolic intracellular Ca 2ϩ concentration ([Ca 2ϩ ]i), a decrease in [Ca 2ϩ ]i transient amplitude, Ca 2ϩ alternans followed by [Ca 2ϩ ]i waves, and failures of Ca 2ϩ release. The decrease in [Ca 2ϩ ]i transient amplitude occurred despite high sarcoplasmic reticulum (SR) Ca 2ϩ load. In voltage-clamped myocytes, palytoxin induced a current with a linear current-voltage relationship (reversal potential ϳ5 mV) that was blocked by ouabain. Whole cell Ca 2ϩ current and ryanodine receptor Ca 2ϩ release channel function remained unaffected by the toxin. However, palytoxin significantly reduced Ca 2ϩ pumping of isolated SR vesicles. In currentclamped myocytes stimulated at 1 Hz, palytoxin induced a depolarization of the resting membrane potential that was accompanied by delayed afterdepolarizations. No major changes of action potential configuration were observed. The results demonstrate that palytoxin interferes with the function of the sarcolemmal Na ϩ -K ϩ pump and the SR Ca 2ϩ pump. The suggested mode of palytoxin toxicity in the atrium involves the conversion of Na ϩ -K ϩ pumps into nonselective cation channels as a primary event followed by depolarization, Na ϩ accumulation, and Ca 2ϩ overload, which, in turn, causes arrhythmogenic [Ca 2ϩ ]i waves and delayed afterdepolarizations. atrial myocytes; intracellular calcium PALYTOXIN IS A NONPEPTIDE TOXIN with a unique chemical structure isolated from corals of the genus Palythoa (34). It is the most potent animal toxin known to date (14, 50). Palytoxin intoxication leads to severe vasoconstriction, depression of cardiac function (25, 50), and, possibly, myocardial damage (36). At the cellular level, the toxin causes Na ϩ influx and K ϩ efflux, accompanied by depolarization, in all mammalian cell types studied (14). Cardiac glycosides (cymarin, ouabain, and digitoxin), specific inhibitors of the Na ϩ -K ϩ pump (Na ϩ -K ϩ -ATPase), can partially or fully antagonize the actions of palytoxin, pointing to the Na ϩ -K ϩ pump as the molecular target of the toxin (14). Nevertheless, several other modes of action have been proposed (10). Recent studies of yeast cells expressing mammalian Na ϩ -K ϩ pumps (39, 46) and of isolated Na ϩ -K ϩ pumps incorporated into planar lipid bilayers (18, 26), however, have shown unambiguously that palytoxin indeed targets the Na ϩ -K ϩ pump, converting the enzyme into a nonselective cation channel (summarized in Ref. 44). Furthermore, elegant kinetic studies of palytoxin-induced channels in cardiac myocytes and HEK-293 cells strongly support the notion that the toxin binds to the pump molecule and locks it in a channel-like open state (2).In the heart, palytoxin leads to myocardial ischemia, ventricular fibrillation, and cardiac fa...