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Atrial proarrhythmias of ivabradine by inducing intracellular calcium overload and delayed afterdepolarizations in rabbit heart
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  • Chengyu Wang,
  • Mingjie Lin,
  • Qiaomei Yang,
  • Gang Li,
  • Xiaoyan Liu,
  • Qing Zhang,
  • Shandong Yu,
  • Lin Wu
Chengyu Wang
Peking University First Hospital
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Mingjie Lin
Peking University First Hospital
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Qiaomei Yang
Peking University First Hospital
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Gang Li
Peking University First Hospital
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Xiaoyan Liu
Peking University First Hospital
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Qing Zhang
Peking University First Hospital
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Shandong Yu
Peking University First Hospital
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Lin Wu
Peking University First Hospital

Corresponding Author:lin_wu@163.com

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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.