Ventricular action potential

Glass IG Antiarrhythmic Agents. Class IC antiarrhythmic agents have marked local anesthetic effects. They slow the rapid inward sodium current producing marked phase 0 depression and slow conduction. Action potential duration of ventricular muscle is increased, ie, prolonged repolarization, but decreased in the His-Purkinie system by these agents. The effects on the ECG are increased PR interval, marked prolongation of the... 

Fleca.inide, Elecainide acetate, a fluorobenzamide, is a derivative of procainamide, and has been reported to be efficacious in suppressing both supraventricular and ventricular arrhythmias (26—29). The dmg is generally reserved for patients with serious and life-threatening ventricular arrhythmias. Elecainide depresses phase 0 depolarization of the action potential, slows conduction throughout the heart, and significantly prolongs repolarization (30). The latter effect indicates flecainide may possess some Class III antiarrhythmic-type properties (31). 

Verapamil. Verapamil hydrochloride (see Table 1) is a synthetic papaverine [58-74-2] C2qH2 N04, derivative that was originally studied as a smooth muscle relaxant. It was later found to have properties of a new class of dmgs that inhibited transmembrane calcium movements. It is a (+),(—) racemic mixture. The (+)-isomer has local anesthetic properties and may exert effects on the fast sodium channel and slow phase 0 depolarization of the action potential. The (—)-isomer affects the slow calcium channel. Verapamil is an effective antiarrhythmic agent for supraventricular AV nodal reentrant arrhythmias (V1-2) and for controlling the ventricular response to atrial fibrillation (1,2,71—73). 

Normal rhythmic activity is the result of the activity of the sinus node generating action potentials that are conducted via the atria to the atrioventricular node, which delays further conduction to the His-Tawara-Purkinje system. From the Purkinje fibres, action potentials propagate to the ventricular myocardium. Arrhythmia means a disturbance of the normal rhythm either resulting in a faster rhythm (tachycardia, still rhythmic) or faster arrhythmia (tachyarrhythmia) or slowed rhythm (bradycardia, bradyarrhythmia). 

Antiarrhythmic Drugs. Figure 1 Transmembrane ionic currents of the cardiac action potential. In the middle of the figure, a typical cardiac action potential is shown as can be obtained from the ventricular myocardium (upper trace). Below, the contribution of the various transmembrane currents is indicated. Currents below the zeroline are inward currents above the zero line are outward fluxes. In the left column the name of the current is given and in the right column the possible clone redrawn and modified after [5]. 

Besides the class I-typical proarrhythmic risk class IA antiarrhythmics possess a marked proarrhythmic risk for the induction of torsade depointes arrhythmia (life-threatening polymorphic ventricular tachycardia observed with most action potential prolonging drugs). 

Second, as in the ventricular muscle fibres of the heart, opening of L-type channels can generate sustained plateau potentials following the initial Na +-mediated action potential — for example, in the rhythmically firing neurons of the inferior olive (Fig. 2.7). 

Figure 4.5 Influence of oxidant stress on action potentials recorded In an isolated rabbit ventricular myocyte, (a) Control action potential, (b) Action potential recorded 3 min after exposure to oxidant stress induced by the photoactivation of rose bengal (50 nu). (c) Spontaneous and repetitive action potential discharges induced 6.5 min after exposure to rose bengal. Action potentials were recorded via a 2.5 MQ suction electrode and a current-clamp amplifier. The cell was stimulated at 0.1 Hz with a 2 ms suprathreshold current pulse and, when the cell showed automaticity (after 6 min), stimulation was stopped. Redrawn from Matsuura and Shattock (1991b).

Pallandi, R.T., Perry, M.A. and Campbell, T.J. (1987). Proar-rhythmic efects of an oxygen-derived free radical generating system on action potentials recorded from guinea pig ventricular myocardium possible cause of reperfusion-induced arrhythmias. Circ. Res. 61, 50-54. 

The ventricular action potential is depicted in Fig. 6-2.2 Myocyte resting membrane potential is usually -70 to -90 mV, due to the action of the sodium-potassium adenosine triphosphatase (ATPase) pump, which maintains relatively high extracellular sodium concentrations and relatively low extracellular potassium concentrations. During each action potential cycle, the potential of the membrane increases to a threshold potential, usually -60 to -80 mV. When the membrane potential reaches this threshold, the fast sodium channels open, allowing sodium ions to rapidly enter the cell. This rapid influx of positive ions... 

Compare and contrast the action potentials generated by the SA node and ventricular muscle cells... 

The action potential generated in the ventricular muscle is very different from that originating in the SA node. The resting membrane potential is not only stable it is much more negative than that of the SA node. Second, the slope of the depolarization phase of the action potential is much steeper. Finally, there is a lengthy plateau phase of the action potential in which the muscle cells remain depolarized for approximately 300 msec. The physiological significance of this sustained depolarization is that it leads to sustained contraction (also about 300 msec), which facilitates ejection of blood. These disparities in the action potentials are explained by differences in ion channel activity in ventricular muscle compared to the SA node. 

The effective refractory period is followed by a relative refractory period that lasts for the remaining 50 msec of the ventricular action potential. During this period, action potentials may be generated however, the myocardium is more difficult than normal to excite. 

Procainamide (Class IA antiarrhythmic drug) is an effective agent for ventricular tachycardia. Its mechanism of action involves blockade of the fast Na+ channels responsible for phase 0 in the fast response tissue of the ventricles. Therefore, its effect is most pronounced in the Purkinje fibers. The effects of this drug s activity include a decrease in excitability of myocardial cells and in conduction velocity. Therefore, a decrease in the rate of the phase 0 upstroke and a prolonged repolarization are observed. As a result, duration of the action potential and the associated refractory period is prolonged and the heart rate is reduced. These effects are illustrated by an increase in the duration of the QRS complex. 

A 5. 5-year-oId male has recurrent ventricular arrhythmias after an Ml, for which he is given an antiarrhythmic agent that blocks Na+ channels and prolongs the action potential. One year later, a blood, test is positive for circulating antinuclear antibodies. 

The ventricular cardiac action potential is characterized by five phases and is shaped by the complex interplay of a variety of Na+, Ca2+ and K+ currents (Figure 4.2). The distinct voltage-dependent properties of hERG channels [19,20] govern the time course of Ikt and the manner in which it contributes to the outward K+ current during the repolarization phase of the cardiac action potential. The opening and closing of... 

Figure 4.2 Cartoon representation of an ECC trace and ventricular cardiac action potential, (a) A representation of an ECC trace with its five typical deflections (PQRST) arising from the spread of electrical activitythrough the heart. The QRS wave denotes the ventricular depolarization, while the T wave represents ventricular repolarization. The QT interval therefore estimates the duration of a ventricular action potential, (b) Schematic of the five phases of a ventricular action potential. Phase 0 is the rapid depolarization phase due to a large influx of Na+ ions (Ina). Phase 1 occurs with the inactivation of Na+ channels and the onset of transient outward (repolarizing) currents (/to)...

---