Atrial proarrhythmias of ivabradine by inducing intracellular calcium
overload and delayed afterdepolarizations in rabbit heart
Abstract
Background: Ivabradine (IVA) inhibits
hyperpolarization-activated cyclic nucleotide channel to reduce pacing
current with a possible increasing risk of atrial fibrillation (AF).
Objective: To determine the effects of IVA on atrial action
potentials, atrial arrhythmic activities and intracellular calcium
homeostasis. Methods: Langendorff-perfused hearts and atrial
myocytes from New Zealand White rabbits were used to record 12-lead
ECGs,left atrial monophasic APs and Ca2+ sparks.
Ca2+ handing related protein from left atrium were
tested using western blotting. Results: IVA (0.1-10 μM) slowed
the HR and prolonged the atrial MAPD90 (n=8,
p<0.05) and induced atrial arrhythmias in 26% and 77% of
hearts paced at cycle lengths of 350 ms and 570 ms, respectively (n=23
and 13, p<0.05). In hearts treated with either 0.3 µM
acetylcholine (ACh) or 2 nM ATX-II with modulated atrial MAPDs, IVA
(0.1-10 µM) caused either shortening or prolongation of
MAPD90, respectively (n=18 and 21, p<0.05) and
atrial arrhythmias in 61.9% and 44.4% of hearts (p<0.05).
IVA induced delayed afterdepolarizations in 41.7%, 62.5% and 50% of
cells in the absence and presence of either ATX-II or ACh, respectively
(n=12, 8 and 8, p<0.05). IVA (0.03-3 μM) increased the
frequency, amplitude and full width at half-maximum (n=22,
p<0.05), and the expression of ryanodine receptor and
Na+/Ca2+ exchanger with decreased
sarcoplasmic reticulum calcium pump (n=4-5, p<0.05).
Conclusion: IVA caused a blunted HR reduction and increased
atrial proarrhythmic risk in hearts with slow rate, enhanced vagal tone
and late INa, and DADs resulting from enhanced
Ca2+ release.