SUMMARY The action potential of guinea pig papillary muscle exposed to the ceveratrum alkaloid germitrine (2 J*M) is followed by a long-lasting after-depolarization (maximal amplitude, 8 mV; half-time of decay, 32 seconds; total duration, -75 seconds). This after-depolarization interrupts the terminal phase of repolarization. During repetitive stimulation (0.1-1.0 Hz; 80 nM germitrine) the after-depolarizations that follow consecutive action potentials are summed, causing persistent depolarization of up to 10 mV. The after-depolarization is reversibly abolished by tetrodotoxin (TTX). Test contractions evoked at various times during or after the germitrine-induced after-depolarization reveal a phase during which the ability of the muscle to develop force is transiently increased. This positive inotropic influence reaches its maximum 1 minute after the conditioning stimulus and thereafter decays with a half-time 4.8 times longer than the half-time of decay of the after-depolarization. It is reversibly abolished by TTX and augmented by dihydro-ouabain (DHO). We conclude: Germitrine induces an after-depolarization by prolonging dramatically the Na permeability component which is mediated by the fast Na channels and normally restricted to the first few milliseconds of the action potential. The germitrine-induced selective and persistent increase of sarcolemmal sodium permeability (P Na ) causes a positive inotropic effect, probably because intracellularly accumulating Na ions exchange for extracellular Ca ions.TWO DIFFERENT mechanisms are currently thought to play a major role in determining the inotropic state of the cardiac muscle cell: inward Ca current during depolarization, and Na-Ca exchange across the sarcolemma.1 The latter concept predicts that a change in the Na concentration gradient across the cell membrane alters the transsarcolemmal distribution of Ca. For instance, an increase of [Na]i at constant [Na] 0 should increase [Ca]|. Changes of [Na]j, by their effect on Na-Ca exchange, may be responsible for the positive inotropic response of cardiac muscle to increased stimulation rates or to cardiac glycosides. With regard to the functional significance of Na-Ca exchange it seemed desirable to test how an intervention which selectively increases the Na permeability (P Na ) of the sarcolemma affects contractile force.The ceveratrum alkaloid veratridine increases P Na of excitable membranes by a specific interaction with the (fast) Na channels. 4 The tetrodotoxin-sensitive prolongation of the cardiac action potential by veratrine 5 or veratridine 6 indicates that a drug-induced increase of P,\ a occurs during each excitation. If an increased sarcolemmal P,va causes a positive inotropic effect via accumulation of Na ions inside the cell, the inotropic response should lag behind the increase in P Na . The test of this prediction is complicated, however, by the relatively short duration of the Na permeability increase associated with veratrine or veratridine. The present publication shows that the germine triest...