Abstract
Atrial fibrillation (AF) and heart failure (HF) are two of the most common cardiovascular diseases. They often coexist and account for significant morbidity and mortality. Alterations in cellular Ca2+ homeostasis play a critical role in AF initiation and maintenance. This study was designed to specifically elucidate AF-associated remodeling of atrial Ca2+ cycling in the presence of mild HF. AF was induced in domestic pigs by atrial burst pacing. The animals underwent electrophysiologic and echocardiographic examinations. Ca2+ handling proteins were analyzed in right atrial tissue obtained from pigs with AF (day 7; n = 5) and compared to sinus rhythm (SR) controls (n = 5). During AF, animals exhibited reduction of left ventricular ejection fraction (from 73% to 58%) and prolonged atrial refractory periods. AF and HF were associated with suppression of protein kinase A (PKA)RII (-62%) and Ca2+-calmodulin-dependent kinase II (CaMKII) δ by 37%, without changes in CaMKIIδ autophosphorylation. We further detected downregulation of L-type calcium channel (LTCC) subunit α2 (-75%), sarcoplasmic reticulum Ca2+-ATPase (Serca) 2a (-29%), phosphorylated phospholamban (Ser16, -92%; Thr17, -70%), and phospho-ryanodine receptor 2 (RyR2) (Ser2808, -62%). Na+-Ca2+ exchanger (NCX) levels were upregulated (+473%), whereas expression of Ser2814-phosphorylated RyR2 and LTCCα1c subunits was not significantly altered. In conclusion, AF produced distinct arrhythmogenic remodeling of Ca2+ handling in the presence of tachycardia-induced mild HF that is different from AF without structural alterations. The changes may provide a starting point for personalized approaches to AF treatment.
Highlights
Effective and safe management of atrial fibrillation (AF) constitutes a major clinical challenge
Uncontrolled tachycardia during AF resulted in impairment of left ventricular ejection fraction (LVEF)
Dephosphorylated PLN that inhibits Serca2a function was associated with reduced expression of CaMKIIδ and phosphorylated regulatory RIIα protein kinase A (PKA) subunits after 7 days of AF
Summary
Effective and safe management of atrial fibrillation (AF) constitutes a major clinical challenge. The co-existence of heart failure (HF), a common clinical scenario, is associated with increased morbidity and mortality, more rapid disease progression, and reduced efficacy of pharmacologic or interventional treatment of the arrhythmia [1,2,3]. Progressive electrical atrial remodeling of ion currents and calcium handling supports initiation and perpetuation of PLOS ONE | DOI:10.1371/journal.pone.0116395. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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