急性低氧对心室肌ATP敏感钾电流的影响

目前,ＡＴＰ敏感钾通道在心律失常发生中的作用还不十分清楚,在心肌缺血时,细胞内钾丢失及其引起的细胞外钾积聚可导致严重的室性心律紊乱。本实验观察到,在正常细胞外钾离子水平下,急性低氧只能引起 部分钾离子外流减少,该部分电流对ＡＴＰ敏钾通道阻断剂优降糖不敏感。     

葛根素对大鼠心室肌细胞动作电位及钾通道电流的影响

目的:观察葛根素对大鼠心室肌细胞动作电位及钾通道电流的影响。方法:用常规微电极方法记录大鼠心室肌细胞动作电位,用全细胞膜片钳技术记录游离心室肌细胞钾离子流。结果:不同浓度的葛根素均能延长大鼠心室肌细胞动作电位时程(APD)及抑制内向整流钾电流,具有明显的浓度依赖关系。结论:葛根素延长APD,抑制内向整流钾电流,可能是其抗心律失常的机制。     

钾通道活化剂对豚鼠气道平滑肌电压依赖性钾通道特性的影响

钾通道活化剂可激活钾离子通道并松驰支气管平滑肌,在急性分离的豚鼠支气管平滑肌细胞上,用膜片钳技术的细胞贴附式和内面向外式研究了其对电压依赖性钾通道的直接作用。结果证实：在全细胞记录条件下,卡吗克林和拉吗克林不影响静息膜电位。但在去极化时可使通道电导从７５．２±５．１ｐＳ分别增大到８５．９±１１．８ｐＳ和８２．１±５．５ｐＳ。通道动力学特性也发生了改变,通道平均开放时间的τｏ２值延长和开放概率显著增加,其中拉吗克林的作用更为强。两者均可诱发通道出现多级开放。表明这两类活化剂可使去极化时钾离子外流增加。     

电压门控性钾通道的结构和调控机制

电压门控性K 通道是由4个相同亚单位构成的四聚体通道,其中每个亚单位都含有1个电压感受器,并且4个亚单位合起来组成1个中央孔.电压门控性通道蛋白具有3种主要功能,一是离子通透功能,二是门控蛋白构象改变,三是门控与感知机制的偶联.通道具有高通透速率和高选择性,通过构象改变的门控机制有3种,一是S6束交叉门控,二是球链门控,三是选择性滤器的门控.     

酸中毒后室性心律失常仿真研究

本文旨在分析酸中毒对心脏电生理活动的影响,探讨其诱发室性心律失常的机制.首先建立了具有pH和钙/钙调素依赖蛋白激酶Ⅱ(calcium/calmodulin dependent protein kinaseⅡ,Ca MKⅡ)调控作用的人体心室酸中毒计算模型,然后模拟了酸中毒过程中细胞和组织电活动的变化,并定量分析了心电图的改变情况.实验结果表明:在酸中毒期间,细胞动作电位时程的缩短和复极离散度的降低导致心电图QT间期缩短、T波幅值和宽度减小.同时,细胞静息电位的抬高和最大去极化速率的降低也促进了组织电兴奋的缓慢传导和传导阻滞.另外,酸中毒后的初期,肌浆网钙超载促进钙释放增多,导致细胞产生延迟后除极(delayed afterdepolarization,DADs),使心电图上表现为室性早搏.而缓慢传导、传导阻滞和室性早搏有利于折返波的产生,进而发展为室速.因此,酸中毒后细胞的触发活动是诱发室性心律失常的主要原因之一.     

卡托普利对急性缺血心肌早期室性心律失常的影响

目的:观察卡托普利对急性心肌缺血早期在体电生理指标的改变,探讨卡托普利对急性心肌梗塞(AMI)早期心律失常的影响。方法:采用S1-S2程控电刺激方法同时测定无心肌缺血对照组(假手术对照组)、AMI早期缺血组(AMI组)和用卡托普利(浓度0.1mg·kg-1·min-1)灌流AMI早期缺血的卡托普利组对家兔心室易损期(VVP)、室颤阈(VFT)、舒张阈(DT)、有效不应期(ERP)、T波顶点与VVP外缘处的时间关系(TT-VVP)等电生理指标。结果:VVP、VFT、DT、ERP和TT-VVP在假手术对照组与AMI组和卡托普利组比较均有显著差异(P<0.01),AMI组与卡托普利组比较亦有显著差异(P<0.01),相对于假手术对照组,AMI组VVP延长,VFT和DT降低,ERP缩短,心室易损期外缘向T波方向延伸增加;相对于AMI组,卡托普利组早期VVP缩短,VFT相对升高,ERP相对延长,心室易损期外缘向T波方向延伸相对减少。结论:卡托普利对急性心肌梗塞早期室性心动过速和/或心室颤动的产生有抑制作用。     

血小板活化因子对豚鼠心室肌细胞动作电位和钾通道的影响

应用全细胞膜片钳技术研究了血小板活化因子(platelet activatingfactor,PAF)对豚鼠心室肌细胞动作电位和钾电流的影响.结果发现,当电极内液ATP浓度为5 mmol/L(模拟正常条件)时,1 μmol/L PAF使APD90由对照的225.8±23.3 ms延长至352.8±29.8ms(n=5,P＜0.05);使IK尾电流在指令电压 30 mV由对照的173.5±16.7 pA降至152.1±11.5 pA(P＜0.05,n=4);使Ikl在指令电压为-120 mV时由对照组的-6.1±1.3 nA降至-5.6±1.1 nA(P＜0.05,n=5);但PAF在生理膜电位范围(-90mV～ 20mV)对IK1没有影响.当电极内液ATP浓度为0mmol/L时,IK·ATP开放(模拟缺血条件),1 μmol/LPAF却显著缩短APD90,由对照的153±24.6 ms缩短至88.2±19.4 ms(n=5,P＜0.01).而用1 μmol/L格列本脲(IK·ATP的特异阻断剂)预处理后,恢复了PAF可显著延长动作电位时程的作用.结果提示,PAF可能扩大缺血心肌和正常心肌细胞动作电位时程的不均一性,是缺血/再灌注性心律失常发生的重要原因.     

多不饱和脂肪酸对成年雪貂心肌钾通道的作用

本研究是在成年雪貂的心肌上研究多不饱和脂肪酸（PUFA）对电压门控钾通道的效应。我们观察到,n-3 PUFA能抑制短时性外向钾电流（Ito)和延迟整流钾电流（IK),而对内向整流钾电流（IK1）则没有明显影响。二十二碳六烯酸（DHA）对Ito和Ik能产生浓度依赖性的抑制作用,其IC50分别为7.5和20μmol/L,但不影响IK1。二十碳五烯酸（EPA）对这三种钾通道的作用与DHA相似。花生四烯酸（5或10μmol/L)先引起IK的抑制,然后引起IK,AA的激活;用环氧合酶抑制剂消炎痛可以阻断花生四烯酸激活IK,AA的作用。不具有抗心律失常作用的单不饱和脂肪酸和饱和脂肪酸都不明显影响这些钾通道的活性。上述实验结果证明,n-3 PUFA能抑制心肌细胞的Ito和IK,但和我们以前报道的PUFA对心肌钠电流和钙电流的作用相比,其对Ito和IK抑制作用的效能较低。n-3 PUFA的抗心律失常效应可能与它们抑制心肌钠、钙、钾通道的作用有关。     

新型钾通道开放剂对心血管ATP-敏感性钾通道基因表达的调节作用

目的：研究脂肪胺类的新型钾通道开放剂（KCO）埃他卡林（Ipt）和氰胍类的KCO吡那地尔（Pin）对大鼠心血管ATP-敏感性钾通道（KATP）的亚基SUR1、SUR2、Kir6．1和Kir6．2等在mRNA水平的调节作用。方法：SD大鼠给药1周后处死并取组织,提取总RNA,利用反转录-聚合酶链式反应（RT-PCR）研究以上基因在mRNA水平的改变。结果：与正常对照相比,心脏组织中,Ipt和Pin对KATP的4个亚基在mRNA水平均无显著影响;主动脉平滑肌上,Ipt对4个亚基的mRNA表达无显著影响,但Pin可显著上调SUR2的mRNA表达;尾动脉平滑肌上,Ipt对Kit6．1／Kit6．2、Pin对SUR2／Kir6．1均有显著下调的作用。结论：心肌、大动脉平滑肌和小动脉平滑肌KATP基因表达的调控不同,Ipt选择性调节小动脉平滑肌Kit6．1／Kit6．2;Ipt对心血管KATP基因表达的调节作用不同于Pin。     

后负荷急性增高在诱发家兔室性心律失常中的作用

无论在迷走神经完整或切断后,急性缩窄麻醉家兔的胸主动脉使血压升高时约半数能诱发少量室性早搏等。但在迷走神经切断后它们潜伏期较短,且可被心得安所阻断.当缩窄胸主动脉或静脉滴注苯肾上腺素使血压预先升高(未出现心律失常)时,可明显增加刺激下丘脑室旁核诱发的室性早搏次数。这在迷走神经切断后更为明显,而且血压预先升得越高,刺激下丘脑越易诱发较多的室性早搏。结果提示,心脏后负荷的急性增高不仅本身可能诱发少数室性早搏,而且可明显增加诱发神经源性心律失常的敏感性。后负荷增高的这种影响可能受迷走神经活动的保护。     

ST段抬高型心肌梗死患者血钾水平与原发性恶性室性心律失常的相关研究

目的:探讨ST段抬高型心肌梗死(STEMI)患者与冠状动脉造影阴性的对照组血钾水平以及低血钾发病率的差异;探讨STEMI患者中原发性恶性室性心律失常组和非原发性恶性室性心律失常组血钾水平的差异.方法:选取2007年1月至2009年11月间STEMI并行直接经皮冠状动脉介入术(直接PCI)患者371例,其中男303例,女68例,平均年龄(56.1±11.7)岁.同时选取冠状动脉造影阴性患者(对照组)161例,其中男性131人,女性30人,平均年龄(56.8±10.3)岁.两组基线资料无显著性差异.将血钾含量＜3.5mmol/l定义为低血钾,比较2组间血钾含量及低血钾发病率.根据直接PCI之前是否发生原发性室颤和持续性室速,将STEMI患者分为原发性恶性室性心律失常组和非原发性恶性室性心律失常组,本组数据所指原发性恶性室性心律失常仅包括直接PCI之前发生的原发性室颤和持续性室速,其中原发性室颤24例,持续性室速11例.比较2组间血钾水平.结果:血钾含量STEMI患者(3.81±0.49)低于对照者(4.03+0.41)mmol/L,差异有统计学意义(t=5.08,P＜0.001).低血钾发病率STEMI(22.6%)高于对照者(6.83%),差异有统计学意义(X2=19.13,P＜0.001).STEMI患者中原发性恶性室性心律失常组和非原发性恶性室性心律失常组的血钾水平差异无统计学意义.结论:STEMI患者急性期存在血钾的下降,我们需要积极纠正低血钾,但低血钾与原发性恶性室性心律失常有无必然联系仍需更深入的研究.     

Calcium-Activated Potassium Current Modulates Ventricular Repolarization in Chronic Heart Failure

The role of I_KCa in cardiac repolarization remains controversial and varies across species. The relevance of the current as a therapeutic target is therefore undefined. We examined the cellular electrophysiologic effects of I_KCa blockade in controls, chronic heart failure (HF) and HF with sustained atrial fibrillation. We used perforated patch action potential recordings to maintain intrinsic calcium cycling. The I_KCa blocker (apamin 100 nM) was used to examine the role of the current in atrial and ventricular myocytes. A canine tachypacing induced model of HF (1 and 4 months, n = 5 per group) was used, and compared to a group of 4 month HF with 6 weeks of superimposed atrial fibrillation (n = 7). A group of age-matched canine controls were used (n = 8). Human atrial and ventricular myocytes were isolated from explanted end-stage failing hearts which were obtained from transplant recipients, and studied in parallel. Atrial myocyte action potentials were unchanged by I_KCa blockade in all of the groups studied. I_KCa blockade did not affect ventricular myocyte repolarization in controls. HF caused prolongation of ventricular myocyte action potential repolarization. I_KCa blockade caused further prolongation of ventricular repolarization in HF and also caused repolarization instability and early afterdepolarizations. SK2 and SK3 expression in the atria and SK3 in the ventricle were increased in canine heart failure. We conclude that during HF, I_KCa blockade in ventricular myocytes results in cellular arrhythmias. Furthermore, our data suggest an important role for I_KCa in the maintenance of ventricular repolarization stability during chronic heart failure. Our findings suggest that novel antiarrhythmic therapies should have safety and efficacy evaluated in both atria and ventricles.     

Oral Lignocaine. Its Absorption and Effectiveness in Ventricular Arrhythmia Control

A preliminary study suggests that the gastrointestinal absorption of lignocaine is predictable and that adequate antiarrhythmic blood concentrations are maintained for four to five hours when 500 mg. is taken with food and for two hours if the drug is taken without food. Ventricular arrhythmias were successfully treated with oral lignocaine in four patients.     

Swelling-activated Gd3+-sensitive Cation Current and Cell Volume Regulation in Rabbit Ventricular Myocytes

The role of swelling-activated currents in cell volume regulation is unclear. Currents elicited by swelling rabbit ventricular myocytes in solutions with 0.6–0.9× normal osmolarity were studied using amphotericin perforated patch clamp techniques, and cell volume was examined concurrently by digital video microscopy. Graded swelling caused graded activation of an inwardly rectifying, time-independent cation current (I_Cir,swell) that was reversibly blocked by Gd³⁺, but I_Cir,swell was not detected in isotonic or hypertonic media. This current was not related to I_K1 because it was insensitive to Ba²⁺. The P_K/P_Na ratio for I_Cir,swell was 5.9 ± 0.3, implying that inward current is largely Na⁺ under physiological conditions. Increasing bath K⁺ increased g_Cir,swell but decreased rectification. Gd³⁺ block was fitted with a K _0.5 of 1.7 ± 0.3 μM and Hill coefficient, n, of 1.7 ± 0.4. Exposure to Gd³⁺ also reduced hypotonic swelling by up to ∼30%, and block of current preceded the volume change by ∼1 min. Gd³⁺-induced cell shrinkage was proportional to I_Cir,swell when I_Cir,swell was varied by graded swelling or Gd³⁺ concentration and was voltage dependent, reflecting the voltage dependence of I_Cir,swell. Integrating the blocked ion flux and calculating the resulting change in osmolarity suggested that I_Cir,swell was sufficient to explain the majority of the volume change at –80 mV. In addition, swelling activated an outwardly rectifying Cl⁻ current, I_Cl,swell. This current was absent after Cl⁻ replacement, reversed at E_Cl, and was blocked by 1 mM 9-anthracene carboxylic acid. Block of I_Cl,swell provoked a 28% increase in swelling in hypotonic media. Thus, both cation and anion swelling-activated currents modulated the volume of ventricular myocytes. Besides its effects on cell volume, I_Cir,swell is expected to cause diastolic depolarization. Activation of I_Cir,swell also is likely to affect contraction and other physiological processes in myocytes.     

Regulation of Cardiac Inward Rectifier Potassium Current (IK1) by Synapse-associated Protein-97

Synapse-associated protein-97 (SAP97) is a membrane-associated guanylate kinase scaffolding protein expressed in cardiomyocytes. SAP97 has been shown to associate and modulate voltage-gated potassium (Kv) channel function. In contrast to Kv channels, little information is available on interactions involving SAP97 and inward rectifier potassium (Kir2.x) channels that underlie the classical inward rectifier current, I_K1. To investigate the functional effects of silencing SAP97 on I_K1 in adult rat ventricular myocytes, SAP97 was silenced using an adenoviral short hairpin RNA vector. Western blot analysis showed that SAP97 was silenced by ∼85% on day 3 post-infection. Immunostaining showed that Kir2.1 and Kir2.2 co-localize with SAP97. Co-immunoprecipitation (co-IP) results demonstrated that Kir2.x channels associate with SAP97. Voltage clamp experiments showed that silencing SAP97 reduced I_K1 whole cell density by ∼55%. I_K1 density at −100 mV was −1.45 ± 0.15 pA/picofarads (n = 6) in SAP97-silenced cells as compared with −3.03 ± 0.37 pA/picofarads (n = 5) in control cells. Unitary conductance properties of I_K1 were unaffected by SAP97 silencing. The major mechanism for the reduction of I_K1 density appears to be a decrease in Kir2.x channel abundance. Furthermore, SAP97 silencing impaired I_K1 regulation by β₁-adrenergic receptor (β1-AR) stimulation. In control, isoproterenol reduced I_K1 amplitude by ∼75%, an effect that was blunted following SAP97 silencing. Our co-IP data show that β1-AR associates with SAP97 and Kir2.1 and also that Kir2.1 co-IPs with protein kinase A and β1-AR. SAP97 immunolocalizes with protein kinase A and β1-AR in the cardiac myocytes. Our results suggest that in cardiac myocytes SAP97 regulates surface expression of channels underlying I_K1, as well as assembles a signaling complex involved in β1-AR regulation of I_K1.     

Improvement of Left Ventricular Function under Cardiac Resynchronization Therapy Goes along with a Reduced Incidence of Ventricular Arrhythmia

Objectives

The beneficial effects of cardiac resynchronization therapy (CRT) are thought to result from favorable left ventricular (LV) reverse remodeling, however CRT is only successful in about 70% of patients. Whether response to CRT is associated with a decrease in ventricular arrhythmias (VA) is still discussed controversially. Therefore, we investigated the incidence of VA in CRT responders in comparison with non-responders.

Methods

In this nonrandomized, two-center, observational study patients with moderate-to-severe heart failure, LV ejection fraction (LVEF) ≤35%, and QRS duration >120 ms undergoing CRT were included. After 6 months patients were classified as CRT responders or non-responders. Incidence of VA was compared between both groups by Kaplan-Meier analysis and Cox regression analysis. ROC analysis was performed to determine the aptitude of LVEF cut-off values to predict VA.

Results

In total 126 consecutive patients (64±11years; 67%male) were included, 74 were classified as responders and 52 as non-responders. While the mean LVEF at baseline was comparable in both groups (25±7% vs. 24±8%; P = 0.4583) only the responder group showed an improvement of LVEF (36±6% vs. 24±7; p<0.0001) under CRT. In total in 56 patients VA were observed during a mean follow-up of 28±14 months, with CRT responders experiencing fewer VA than non-responders (35% vs. 58%, p<0.0061). Secondary preventive CRT implantation was associated with a higher likelihood of VA. As determined by ROC analysis an increase of LVEF by >7% was found to be a predictor of a significantly lower incidence of VA (AUC = 0.606).

Conclusions

Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia.     

Prevalence of Ventricular Arrhythmia and Its Associated Factors in Nondialyzed Chronic Kidney Disease Patients

Background and Objectives

Sudden cardiac death is the most common cause of mortality in chronic kidney disease patients, and it occurs mostly due to ventricular arrhythmias. In this study, we aimed at investigating the prevalence of ventricular arrhythmia and the factors associated with its occurrence in nondialyzed chronic kidney disease patients.

Design, Setting, Participants and Measurements

This cross-sectional study evaluated 111 chronic kidney disease patients (estimated glomerular filtration rate 34.7±16.1 mL/min/1.73 m², 57±11.4 years, 60% male, 24% diabetics). Ventricular arrhythmia was assessed by 24-hour electrocardiogram. Left ventricular hypertrophy (echocardiogram), 24-hour ambulatory blood pressure monitoring, and coronary artery calcification (multi-slice computed tomography) and laboratory parameters were also evaluated.

Results

Ventricular arrhythmia was found in 35% of the patients. Non-controlled hypertension was observed in 21%, absence of systolic decency in 29%, left ventricular hypertrophy in 27%, systolic dysfunction in 10%, and coronary artery calcification in 49%. Patients with ventricular arrhythmia were older (p<0.001), predominantly men (p = 0.009), had higher estimated glomerular filtration rate (p = 0.03) and hemoglobin (p = 0.005), and lower intact parathyroid hormone (p = 0.024) and triglycerides (p = 0.011) when compared to patients without ventricular arrhythmia. In addition, a higher left ventricular mass index (p = 0.002) and coronary calcium score (p = 0.002), and a lower ejection fraction (p = 0.001) were observed among patients with ventricular arrhythmia. In the multiple logistic regression analysis, aging, increased hemoglobin levels and reduced ejection fraction were independently related to the presence of ventricular arrhythmia.

Conclusions

Ventricular arrhythmia is prevalent in nondialyzed chronic kidney disease patients. Age, hemoglobin levels and ejection fraction were the factors associated with ventricular arrhythmia in these patients.     

Identification of ATP-sensitive Potassium Channel in Frog Ventricular Myocytes

Nuclear magnetic resonance (NMR) microimaging and proton relaxation times were used to monitor differences between the hydration state of the nucleus and cytoplasm in the Rana pipiens oocyte. Individual isolated ovarian oocytes were imaged in a drop of Ringer's solution with an in-plane resolution of 80 μm. Proton spin echo images of oocytes arrested in prophase I indicated a marked difference in contrast between nucleoplasm and cytoplasm with additional intensity gradations between the yolk platelet-rich region of the cytoplasm and regions with little yolk. Neither shortening τ_e (spin echo time) to 9 msec (from 18 msec) nor lengthening τ_r (spin recovery time) to 2 sec (from 0.5 sec) reduced the observed contrast between nucleus and cytoplasm. Water proton T₁ (spin-lattice) relaxation times of oocyte suspensions indicated three water compartments that corresponded to extracellular medium (T₁= 3.0 sec), cytoplasm (T₁= 0.8 sec) and nucleoplasm (T₁= 1.6 sec). The 1.6 sec compartment disappeared at the time of nuclear breakdown. Measurements of plasma and nuclear membrane potentials with KCl-filled glass microelectrodes demonstrated that the prophase I oocyte nucleus was about 25 mV inside positive relative to the extracellular medium. A model for the prophase-arrested oocyte is proposed in which a high concentration of large impermeant ions together with small counter ions set up a Donnan-type equilibrium that results in an increased distribution of water within the nucleus in comparison with the cytosol. This study indicates: (i) a slow exchange between two or more intracellular water compartments on the NMR time-scale, (ii) an increased rotational correlation time for water molecules in both the cytoplasmic and nuclear compartments compared to bulk water, and (iii) a higher water content (per unit dry mass) of the nucleus compared to the cytoplasm, and (iv) the existence of a large (about 75 mV positive) electropotential difference between the nuclear and cytoplasmic compartments. Received: 18 January 1996/Revised: 29 April 1996     

全心缺血早期阶段室性心律失常仿真研究

为了分析全心缺血早期阶段对心脏电生理活动的影响,以及探讨诱发的室性心律失常机制,本研究考虑了缺血情况下高钾、酸液过多、局部缺氧的情况,结合详细的人类心室细胞生物物理上的动力学特征,开发了一个人体心室细胞和组织全心缺血模型.实验结果表明,全心缺血缩短了动作电位时程(action potential duration,APD),且减缓了兴奋的传导速率(conduction velocity,CV).同时,由于全心缺血降低了动作电位时程曲线(action potential duration restitution,APDR)斜率,且增大了有效不应期(effective refractory period,ERP),因此有利于维持折返波的稳定传导,使得室速不易转化为室颤.另一方面,尽管全心缺血导致了组织易感性的增加,但是由于其需要更长的异位刺激长度来保证折返波的形成,因此也在一定程度上降低了心律失常的发生概率.