Single Sinoatrial Node Research Articles

Universal Inverse Square Relationship between Heart Rate Variability and Heart Rate

In our previous study, we analyzed heart rate variability and heart rate from a large variety of cardiac preparations (including humans, living animals, Langendorff-perfused isolated hearts, and single sinoatrial nodal cells) in diverse species, combining our data with those of previously published articles. The analysis revealed that regardless of conditions, heart rate variability (for the purposes of the study assessed as standard deviation) of beat-to-beat intervals heart rate follows a universal exponential decay-like relationship. Numerical simulations of DI variability by adding a randomly fluctuating term to net current revealed a similar relationship. In the present study, using a Taylor series, we found that this relationship is, in fact, inverse square, and we derive an explicit formula for sd(CL) vs. heart rate with biophysically meaningful parameters.

Heterogeneity of calcium clock functions in dormant, dysrhythmically and rhythmically firing single pacemaker cells isolated from SA node

Current understanding of how cardiac pacemaker cells operate is based mainly on studies in isolated single sinoatrial node cells (SANC), specifically those that rhythmically fire action potentials similar to the in vivo behavior of the intact sinoatrial node. However, only a small fraction of SANC exhibit rhythmic firing after isolation. Other SANC behaviors have not been studied.Here, for the first time, we studied all single cells isolated from the sinoatrial node of the guinea pig, including traditionally studied rhythmically firing cells (‘rhythmic SANC’), dysrhythmically firing cells (‘dysrhythmic SANC’) and cells without any apparent spontaneous firing activity (‘dormant SANC’). Action potential-induced cytosolic Ca2+ transients and spontaneous local Ca2+ releases (LCRs) were measured with a 2D camera.LCRs were present not only in rhythmically firing SANC, but also in dormant and dysrhythmic SANC. While rhythmic SANC were characterized by large LCRs synchronized in space and time towards late diastole, dysrhythmic and dormant SANC exhibited smaller LCRs that appeared stochastically and were widely distributed in time. β-adrenergic receptor (βAR) stimulation increased LCR size and synchronized LCR occurrences in all dysrhythmic and a third of dormant cells (25 of 75 cells tested). In response to βAR stimulation, these dormant SANC developed automaticity, and LCRs became coupled to spontaneous action potential-induced cytosolic Ca2+ transients. Conversely, dormant SANC that did not develop automaticity showed no significant change in average LCR characteristics. The majority of dysrhythmic cells became rhythmic in response to βAR stimulation, with the rate of action potential-induced cytosolic Ca2+ transients substantially increasing. In summary, isolated SANC can be broadly categorized into three major populations: dormant, dysrhythmic, and rhythmic. We interpret our results based on simulations of a numerical model of SANC operating as a coupled-clock system. On this basis, the two previously unstudied dysrhythmic and dormant cell populations have intrinsically partially or completely uncoupled clocks. Such cells can be recruited to fire rhythmically in response to βAR stimulation via increased rhythmic LCR activity and ameliorated coupling between the Ca2+ and membrane clocks.

A computational model of a human single sinoatrial node cell

For the investigation of the spontaneous rhythmical activity response in the application of cardiac neuromodulation, we formulated a human sinoatrial node (SAN) cell model. With the aim of decreasing elevated heart rate (HR), we want to establish a hardware-in-the-loop system including this model for the analysis of optimal stimulation patterns of the neurostimulation system. Base model structures are adopted from rabbit SAN cell models available in literature and conveyed with Hodgkin–Huxley-type model equations describing the complex time and voltage dependent activation and deactivation processes of individual ion channels. The resulting model consists of 15 currents which are currently known to be responsible for the generation of the membrane action potential (AP). The model reproduces AP frequencies equivalent to those measured in isolated human SAN cells with a resulting HR of 71.8 bpm. Model validation via simulation of the inhibitory effect of ivabradine showed accordance with experimental results obtained in human studies. Furthermore, we could validate the model in regard to its HR effects upon parasympathetic stimulation with results obtained in a human trial study.

Comprehensive multilevel in vivo and in vitro analysis of heart rate fluctuations in mice by ECG telemetry and electrophysiology.

The normal heartbeat slightly fluctuates around a mean value; this phenomenon is called physiological heart rate variability (HRV). It is well known that altered HRV is a risk factor for sudden cardiac death. The availability of genetic mouse models makes it possible to experimentally dissect the mechanism of pathological changes in HRV and its relation to sudden cardiac death. Here we provide a protocol that allows for a comprehensive multilevel analysis of heart rate (HR) fluctuations. The protocol comprises a set of techniques that include in vivo telemetry and in vitro electrophysiology of intact sinoatrial network preparations or isolated single sinoatrial node (SAN) cells. In vitro preparations can be completed within a few hours, with data acquisition within 1 d. In vivo telemetric ECG requires 1 h for surgery and several weeks for data acquisition and analysis. This protocol is of interest to researchers investigating cardiovascular physiology and the pathophysiology of sudden cardiac death.

Clinical Implications

HomeHypertensionVol. 64, No. 6Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Dec 2014https://doi.org/10.1161/HYPERTENSIONAHA.114.04776Hypertension. 2014;64:1159Heart Rate Variability and Heart Rate (page 1334)Download figureDownload PowerPointHeart rate variability (HRV) was developed as a marker of cardiac autonomic tone and cardiovascular risk, attracting >17 000 publications on PubMed. Few of these acknowledge the dependent relationship between HRV and heart rate (HR). This means that differences in HRV measured at different HRs are often in part or in full attributable to the different HR at which they were measured. Articles that do acknowledge this relationship often make linear corrections for HR, which are inadequate because the relationship between HRV and HR is nonlinear. In this issue of Hypertension, Monfredi et al use their own data from in vivo records, Langendorff-perfused hearts and isolated single sinoatrial node cells, as well as data from a wide variety of other clinical and nonclinical HRV articles, to demonstrate that regardless of the conditions/species/cardiac preparation, there is a universal exponential decay-like relationship between HRV and HR. They develop 2 biophysical models to explore this, concluding that HRV differences between 2 steady states are primarily dependent on the differences in HR between these 2 states and cannot be used in any simple way to assess differences in cardiac autonomic activity. Their findings suggest that articles that have shown differences in HRV between ≥2 steady states at different HRs may need their conclusions revisited: this may have implications for other types of variability, including blood pressure variability.Bioencapsulated Angiotensin-Con verting Enzyme 2/Angiotensin-(1-7) for Oral Pulmonary Hypertension Therapy (page 1248)Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by elevated blood pressure in the pulmonary arteries. Vasoconstriction, cellular proliferation, and a prothrombotic state result in increased resistance in the lungs leading to right ventricular dysfunction and failure. Restoration of the diminished angiotensin-converting enzyme 2/angiotensin-(1-7) (ACE2/Ang-(1-7)) axis through genetic overexpression or activation of ACE2 is effective against PAH and intravenous injections of recombinant ACE2 are progressing into human clinical trials. However, current protein drugs are not available for a majority of the global population because their production requires expensive fermenters, purification, cold storage, short shelf life, and sterile delivery methods. In addition, repetitive injections may require frequent hospital visits and affect patient compliance. In the current issue of Hypertension, Shenoy et al report a novel approach to oral delivery of ACE2 or Ang-(1-7), which were expressed and bioencapsulated in plant cells, that are protected from digestive acids/enzymes but are released in the gut after lyses of plant cells by commensal bacteria colonizing the gut. In this study, oral delivery of plant cells containing ACE2 or Ang-(1-7) significantly improved cardiopulmonary structure and functions in rats with monocrotaline-induced PAH in both prevention and reversal protocols. Not only was right ventricular systolic blood pressure decreased but the pulmonary blood flow was also improved. Interestingly, oral ACE2/Ang-(1-7) feeding restored right heart function and attenuated maladaptive remodeling in diseased animals. Thus, the study demonstrates that oral feeding of ACE2 or Ang-(1-7) is effective against PAH, and this strategy is ready for clinical trials with a view to producing affordable PAH therapeutics.Download figureDownload PowerPointDiabetes Mellitus, Endothelium, and Cardiovascular Events (page 1299)Download figureDownload PowerPointIn the pathogenesis of cardiovascular events, interaction (ie, synergy) between risk factors has seldom been identified. From a clinical point of view, detection of interaction between risk factors is, however, important because this identifies key therapeutic targets: interventions aimed at such risk factors are potentially more efficacious than treatment of risk factors that do not interact. In this issue of Hypertension, van Sloten et al used prospective data of the Hoorn Study to evaluate the interaction between endothelial dysfunction, as measured by flow-mediated dilatation, and type 2 diabetes mellitus, impaired glucose metabolism and insulin resistance with regard to risk of cardiovascular events. The results of the study showed that endothelial dysfunction and type 2 diabetes mellitus, impaired glucose metabolism, or insulin resistance synergistically increase cardiovascular event risk. That is, individuals with type 2 diabetes mellitus, impaired glucose metabolism, or insulin resistance were found to be particularly sensitive to the adverse cardiovascular effects of endothelial dysfunction, in contrast to individuals with normal glucose metabolism or normal insulin sensitivity. Thereby, this study identifies endothelial dysfunction as a key therapeutic target for prevention of cardiovascular events in individuals with type 2 diabetes mellitus. In addition, the fact that an interaction was already present in individuals with impaired glucose metabolism, and insulin resistance identifies endothelial dysfunction as an early therapeutic target even before onset of type 2 diabetes mellitus. Previous Back to top Next FiguresReferencesRelatedDetails December 2014Vol 64, Issue 6 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.114.04776 Originally publishedDecember 1, 2014 PDF download Advertisement

Beat-to-Beat Variation in Periodicity of Local Calcium Releases Contributes to Intrinsic Variations of Spontaneous Cycle Length in Isolated Single Sinoatrial Node Cells

Spontaneous, submembrane local Ca2+ releases (LCRs) generated by the sarcoplasmic reticulum in sinoatrial nodal cells, the cells of the primary cardiac pacemaker, activate inward Na+/Ca2+-exchange current to accelerate the diastolic depolarization rate, and therefore to impact on cycle length. Since LCRs are generated by Ca2+ release channel (i.e. ryanodine receptor) openings, they exhibit a degree of stochastic behavior, manifested as notable cycle-to-cycle variations in the time of their occurrence.AimThe present study tested whether variation in LCR periodicity contributes to intrinsic (beat-to-beat) cycle length variability in single sinoatrial nodal cells.MethodsWe imaged single rabbit sinoatrial nodal cells using a 2D-camera to capture LCRs over the entire cell, and, in selected cells, simultaneously measured action potentials by perforated patch clamp.ResultsLCRs begin to occur on the descending part of the action potential-induced whole-cell Ca2+ transient, at about the time of the maximum diastolic potential. Shortly after the maximum diastolic potential (mean 54±7.7 ms, n = 14), the ensemble of waxing LCR activity converts the decay of the global Ca2+ transient into a rise, resulting in a late, whole-cell diastolic Ca2+ elevation, accompanied by a notable acceleration in diastolic depolarization rate. On average, cells (n = 9) generate 13.2±3.7 LCRs per cycle (mean±SEM), varying in size (7.1±4.2 µm) and duration (44.2±27.1 ms), with both size and duration being greater for later-occurring LCRs. While the timing of each LCR occurrence also varies, the LCR period (i.e. the time from the preceding Ca2+ transient peak to an LCR’s subsequent occurrence) averaged for all LCRs in a given cycle closely predicts the time of occurrence of the next action potential, i.e. the cycle length.ConclusionIntrinsic cycle length variability in single sinoatrial nodal cells is linked to beat-to-beat variations in the average period of individual LCRs each cycle.

Stochastic Beat-To-Beat Variation in Periodicity of Local Calcium Releases Predicts Intrinsic Cycle Length Variability in Single Sinoatrial Node Cells

Abstract: In sinoatrial nodal cells (SANC), spontaneous, rhythmic, submembrane sarcoplasmic reticulum (SR)-generated local Ca2+ releases (LCRs) that occur during diastolic depolarization (DD) activate inward Na+/Ca2+-exchange currents that accelerate the DD rate. LCRs are roughly periodic, ‘LCR period’ being the time from the preceding AP-induced Ca2+-transient peak to their subsequent appearance. Previously, we demonstrated that in a given steady-state, the average LCR period of multiple AP cycles predicts concurrent average steady-state AP cycle length. We tested whether variation in LCR periods also predicts the beat-to-beat cycle length within a given steady-state. Methods: We imaged single rabbit SANC using a fast 2D-camera to capture almost all LCRs (in contrast to the relative few LCRs captured by line scan images), and in selected cells we also simultaneously measured APs by perforated patch clamp. Results: LCRs begin to occur very early during diastole, on the descending part of the prior AP-induced Ca2+ transient, shortly after the maximum diastolic potential (MDP). About 40 ms after the MDP, the ensemble of waxing LCR activity causes a late diastolic Ca elevation accompanied by a notable DD acceleration. On average, SANC (n = 9) generated 13.2 ± 3.7 LCRs per cycle, varying in size (7.1 ± 4.2µm) and duration (44.2 ± 27.1 ms). The LCR size and duration were greater for later-occurring LCRs. The average LCR period for a given cycle ranged from 70-460ms, and closely predicted (R2=0.89) the time of occurrence of the next AP, i.e. the duration of that cycle (220 to 470 ms). Numerical modeling simulations closely reproduce this experimental result. Conclusion: Intrinsic cycle length variability in single SANC is linked to cycle to cycle stochastic variations in roughly periodic LCRs.

Phase response characteristics of sinoatrial node cells

In this work, the dynamic response of the sinoatrial node (SAN), the natural pacemaker of the heart, to short external stimuli is investigated using the Zhang et al. model. The model equations are solved twice for the central cell and for the peripheral cell. A short current pulse is applied to reset the spontaneous rhythmic activity of the single sinoatrial node cell. Depending on the stimulus timing either a delay or an advance in the occurrence of next action potential is produced. This resetting behavior is quantified in terms of phase transition curves (PTCs) for short electrical current pulses of varying amplitude which span the whole period. For low stimulus amplitudes the transition from advance to delay is smooth, while at higher amplitudes abrupt changes and discontinuities are observed in PTCs. Such discontinuities reveal critical stimuli, the application of which can result in annihilation of activity in central SAN cells. The detailed analysis of the ionic mechanisms involved in its resetting behavior of sinoatrial node cell models provides new insight into the dynamics and physiology of excitation of the sinoatrial node of the heart.

Species‐ and Preparation‐Dependence of Stretch Effects on Sino‐Atrial Node Pacemaking

Acute dilation of the right atrium (e.g., via increased venous return) raises spontaneous beating rate (BR) of the heart in many species. Neural mechanisms contribute to this behavior in vivo, but a positive chronotropic response to stretch can also be observed in isolated right atrial tissue preparations and even at the level of single sino-atrial node (SAN) cells. The underlying mechanism has previously been reported to be compatible with stretch-activation of cation nonselective ion channels (SAC). This review reports species peculiarities in the chronotropic response of isolated SAN tissue strips to stretch: in contrast to guinea pig, murine SAN preparations respond to distension with a reduction in spontaneous BR. This differential response need not necessarily involve disparate (sub-)cellular mechanisms, as SAC activation would occur against the background of very different SAN electrophysiology in the two species. On the basis of single SAN cell action potential recordings, this review illustrates how this may give rise to potentially opposing effects on spontaneous BR. Interestingly, streptomycin (a useful SAC blocker in isolated cells) has no effect on stretch-induced chronotropy in situ, and this is interpreted as an indication of protection of SAC, in native tissue, from interaction with the drug.

Effects of C-type natriuretic peptide on ionic currents in mouse sinoatrial node: a role for the NPR-C receptor.

The effects of C-type natriuretic peptide (CNP) on heart rate and ionic currents were demonstrated by recording the ECG from adult mice and performing voltage-clamp experiments on single sinoatrial (SA) node cells isolated from mouse heart. The selective natriuretic peptide type C receptor (NPR-C) agonist cANF (10(-7) M) significantly decreased heart rate in the presence of isoproterenol (5 x 10(-9) M), as indicated by an increase in the R-R interval of ECGs obtained from Langendorff-perfused hearts. Voltage-clamp measurements in enzymatically isolated single pacemaker myocytes revealed that CNP (10(-8) M) and cANF (10(-8) M) significantly inhibited L-type Ca2+ current [ICa(L)]. These findings suggest that the CNP effect on this current is mediated by NPR-C. Further support for an NPR-C-mediated inhibition of ICa(L) in SA node myocytes was obtained by altering the functional coupling between the G protein Gi and NPR-C. In these experiments, a "Gi-activator peptide," which consists of a 17-amino acid segment of NPR-C containing a specific Gi protein-activator sequence, was dialyzed into SA node myocytes. This peptide decreased ICa(L) significantly, suggesting that NPR-C activation can result in a reduction in ICa(L) when CNP is bound and the Gi protein pathway is activated. This effect of CNP appears to be selective for ICa(L), because the hyperpolarization-activated current was unaffected by CNP or cANF. These results provide the first demonstration that CNP has a negative chronotropic effect on heart rate and suggest that this effect is mediated by selectively activating NPR-C and reducing ICa(L) through coupling to Gi protein.

Ca(2+)-activated Cl(-) current in rabbit sinoatrial node cells.

The Ca(2+)-activated Cl(-) current (I(Cl(Ca))) has been identified in atrial, Purkinje and ventricular cells, where it plays a substantial role in phase-1 repolarization and delayed after-depolarizations. In sinoatrial (SA) node cells, however, the presence and functional role of I(Cl(Ca)) is unknown. In the present study we address this issue using perforated patch-clamp methodology and computer simulations. Single SA node cells were enzymatically isolated from rabbit hearts. I(Cl(Ca)) was measured, using the perforated patch-clamp technique, as the current sensitive to the anion blocker 4,4'-diisothiocyanostilbene-2,2'-disulphonic acid (DIDS). Voltage clamp experiments demonstrate the presence of I(Cl(Ca)) in one third of the spontaneously active SA node cells. The current was transient outward with a bell-shaped current-voltage relationship. Adrenoceptor stimulation with 1 microM noradrenaline doubled the I(Cl(Ca)) density. Action potential clamp measurements demonstrate that I(Cl(Ca)) is activate late during the action potential upstroke. Current clamp experiments show, both in the absence and presence of 1 microM noradrenaline, that blockade of I(Cl(Ca)) increases the action potential overshoot and duration, measured at 20 % repolarization. However, intrinsic interbeat interval, upstroke velocity, diastolic depolarization rate and the action potential duration measured at 50 and 90 % repolarization were not affected. Our experimental data are supported by computer simulations, which additionally demonstrate that I(Cl(Ca)) has a limited role in pacemaker synchronization or action potential conduction. In conclusion, I(Cl(Ca)) is present in one third of SA node cells and is activated during the pacemaker cycle. However, I(Cl(Ca)) does not modulate intrinsic interbeat interval, pacemaker synchronization or action potential conduction.

Heterogeneous expression of the delayed-rectifier K+ currents i(K,r) and i(K,s) in rabbit sinoatrial node cells.

1. The electrical activity of sinoatrial node cells is heterogeneous. To understand the reasons for this, the density of the delayed-rectifier K+ current and its two components, i(K,r) and i(K,s), as a function of the size (as measured by cell capacitance) of rabbit sinoatrial node cells was investigated using the whole-cell voltage-clamp technique at 35 degrees C. 2. i(K,r) and i(K,s) were isolated using E-4031 and 293B. Features of the E-4031-sensitive and 293B-insensitive currents corresponded well to those of i(K,r), while features of the E-4031-insensitive and 293B-sensitive currents corresponded well to those of i(K,s). 3. The densities of the outward current under control conditions and the drug-sensitive and -insensitive currents were significantly (P < 0.01) correlated with cell capacitance, with current densities being greater in larger cells. 4. The effects of partial blockade of i(K,r) by 0.1 microM E-4031 on spontaneous action potentials were greater in smaller cells. 5. It is concluded that there are cell size-dependent differences in the density of the i(K,r) and i(K,s) components, and these may be involved in the heterogeneity of the electrical activity of single sinoatrial node cells as well as that of the intact sinoatrial node.

Localisation and functional significance of ryanodine receptors during beta-adrenoceptor stimulation in the guinea-pig sino-atrial node.

Recent evidence shows that calcium released from the sarcoplasmic reticulum (SR) plays an important role in the regulation of heart rate. The aim of this study was to investigate the subcellular distribution of ryanodine receptors in the guinea-pig sino-atrial (SA) node and to determine their functional role in the regulation of pacemaker frequency in response to beta-adrenoceptor stimulation. Monoclonal antibodies raised against the cardiac ryanodine receptor were used with confocal microscopy to investigate ryanodine receptor distribution in single guinea-pig SA node cells. The functional role of ryanodine receptors was investigated in both multicellular SA node/atrial preparations and in single SA node cells. Ryanodine receptor labelling was observed in all SA node cells studied and showed both subsarcolemmal and intracellular staining. In the latter, labelling appeared as transverse bands with a regular periodicity of approximately 2 microm. This interval resembled that of the expected sarcomere spacing but did not, however, depend on the presence of transverse tubules. The bands of ryanodine receptors appeared to be located in the region of the Z lines, based on co-distribution studies with antibodies to alpha-actinin, myomesin and binding sites for phalloidin. Functional studies on single SA node cells showed that application of ryanodine (2 micromol/l) reduced the rate of firing of spontaneous action potentials (measured using the perforated patch clamp technique) and this was associated with changes in action potential characteristics. Ryanodine also significantly decreased the positive chronotropic actions of isoprenaline in both multicellular and single cell preparations. In single cells exposed to 100 nmol/l isoprenaline, ryanodine caused a decrease in the rate of firing and this was associated with a decrease in the amplitude of the measured calcium transients. These findings are the first to show immunocytochemical evidence for the presence and organisation of ryanodine receptor calcium release channels in mammalian SA node cells. This study also provides evidence of a role for ryanodine sensitive sites in the beta-adrenergic modulation of heart rate in this species.

Sinoatrial Node Pacemaker Activity Requires Ca 2+ /Calmodulin-Dependent Protein Kinase II Activation

Cardiac beating arises from the spontaneous rhythmic excitation of sinoatrial (SA) node cells. Here we report that SA node pacemaker activity is critically dependent on Ca(2+)/calmodulin-dependent protein kinase II (CaMKII). In freshly dissociated rabbit single SA node cells, inhibition of CaMKII by a specific peptide inhibitor, autocamtide-2 inhibitory peptide (AIP, 10 micromol/L), or by KN-93 (0.1 to 3.0 micromol/L), but not its inactive analog, KN-92, depressed the rate and amplitude of spontaneous action potentials (APs) in a dose-dependent manner. Strikingly, 10 micromol/L AIP and 3 micromol/L KN-93 completely arrested SA node cells, which indicates that basal CaMKII activation is obligatory to the genesis of pacemaker AP. To understand the ionic mechanisms of the CaMKII effects, we measured L-type Ca(2+) current (I(Ca, L)), which contributes both to AP upstroke and to pacemaker depolarization. KN-93 (1 micromol/L), but not its inactive analog, KN-92, decreased I:(Ca, L) amplitude from 12+/-2 to 6+/-1 pA/pF without altering the shape of the current-voltage relationship. Both AIP and KN-93 shifted the midpoint of the steady-state inactivation curve leftward and markedly slowed the recovery of I(Ca, L) from inactivation. Similar results were observed using the fast Ca(2+) chelator BAPTA, whereas the slow Ca(2+) chelator EGTA had no significant effect, which suggests that CaMKII activity is preferentially regulated by local Ca(2+) transients. Indeed, confocal immunocytochemical imaging showed that active CaMKII is highly localized beneath the surface membrane in the vicinity of L-type channels and that AIP and KN-93 significantly reduced CaMKII activity. Thus, we conclude that CaMKII plays a vital role in regulating cardiac pacemaker activity mainly via modulating I(Ca, L) inactivation and reactivation, and local Ca(2+) is critically involved in these processes.

The sinoatrial node, a heterogeneous pacemaker structure.

This article focuses on the regional heterogeneity of the mammalian sinoatrial (SA) node in terms of cell morphology, pacemaker activity, action potential configuration and conduction, densities of ionic currents (i(Na), i(Ca,L), i(to), i(K,r), i(K,s) and i(f)), expression of gap junction proteins (Cx40, Cx43 and Cx45), autonomic regulation, and ageing. Experimental studies on the single SA node cell to the whole animal are reviewed. The heterogeneity is considered in terms of the gradient model of the SA node, in which there is gradual change in the intrinsic properties of SA node cells from periphery to centre, and the alternative mosaic model, in which there is a variable mix of atrial and SA node cells from periphery to centre. The heterogeneity is important for the dependable functioning of the SA node as the pacemaker for the heart, because (i) via multiple mechanisms, it allows the SA node to drive the surrounding atrial muscle without being suppressed electrotonically; (ii) via an action potential duration gradient and a conduction block zone, it promotes antegrade propagation of excitation from the SA node to the right atrium and prevents reentry of excitation; and (iii) via pacemaker shift, it allows pacemaking to continue under diverse pathophysiological circumstances.

Contribution of L-type Ca2+ current to electrical activity in sinoatrial nodal myocytes of rabbits.

The role of L-type calcium current (ICa,L) in impulse generation was studied in single sinoatrial nodal myocytes of the rabbit, with the use of the amphotericin-perforated patch-clamp technique. Nifedipine, at a concentration of 5 microM, was used to block ICa,L. At this concentration, nifedipine selectively blocked ICa,L for 81% without affecting the T-type calcium current (ICa,T), the fast sodium current, the delayed rectifier current (IK), and the hyperpolarization-activated inward current. Furthermore, we did not observe the sustained inward current. The selective action of nifedipine on ICa,L enabled us to determine the activation threshold of ICa,L, which was around -60 mV. As nifedipine (5 microM) abolished spontaneous activity, we used a combined voltage- and current-clamp protocol to study the effects of ICa,L blockade on repolarization and diastolic depolarization. This protocol mimics the action potential such that the repolarization and subsequent diastolic depolarization are studied in current-clamp conditions. Nifedipine significantly decreased action potential duration at 50% repolarization and reduced diastolic depolarization rate over the entire diastole. Evidence was found that recovery from inactivation of ICa,L occurs during repolarization, which makes ICa,L available already early in diastole. We conclude that ICa,L contributes significantly to the net inward current during diastole and can modulate the entire diastolic depolarization.

Cesium effects on i(f) and i(K) in rabbit sinoatrial node myocytes: implications for SA node automaticity.

Cesium blocks the hyperpolarization-activated current i(f) but blocks neither the delayed-rectifier current i(K) nor the sinoatrial (SA) node discharge. It has been proposed that the failure of Cs+ to block SA discharge is either an incomplete block or a negative shift of i(f). However, an alternative possibility is that i(K) (rather than i(f)) has a predominant role in the SA-pacemaker potential. To investigate this point, the effects of Cs+ on both i(f) and i(K) in the pacemaker range of potentials were studied in the same single SA node cell at the same time by means of the perforated patch-clamp technique. Hyperpolarizing steps from a holding potential (Vh) of -35 mV into and past the pacemaker-potential range resulted in a progressively larger i(f) associated with an increasing slope conductance. Cs+ (2 mM) reversibly blocked both i(f) and the slope conductance increase, suggesting that the current activated was indeed predominantly i(f). Subsequently, hyperpolarizing steps to -50, -60, and -70 mV were applied in the absence (to activate only i(f)) and in the presence of a prior depolarizing step to +10 mV (to activate i(K) as well, as the action potential normally does). Cs+ almost abolished i(f) but only slightly decreased i(K). It is concluded that the failure of Cs+ to block the SA- node spontaneous discharge is not due to a shift of i(f) out of the pacemaker range (due to run-down) or an incomplete block of i(f). Instead, the resistance of i(K) to block by Cs+ is consistent with a predominant role of i(K) for the discharge of the SA node, although i(f) can contribute under normal or special circumstances. The reduction of i(K) by Cs+ raises the question whether the Cs+ slows the SA-node discharge not only by suppressing I(f), but also by reducing i(K).

Electrical interactions between a rabbit atrial cell and a nodal cell model.

Atrial activation involves interactions between cells with automaticity and slow-response action potentials with cells that are intrinsically quiescent with fast-response action potentials. Understanding normal and abnormal atrial activity requires an understanding of this process. We studied interactions of a cell with spontaneous activity, represented by a "real-time" simulation of a model of the rabbit sinoatrial (SA) node cell, simultaneously being electrically coupled via our "coupling clamp" circuit to a real, isolated atrial myocyte with variations in coupling conductance (Gc) or stimulus frequency. The atrial cells were able to be driven at a regular rate by a single SA node model (SAN model) cell. Critical Gc for entrainment of the SAN model cell to a nonstimulated atrial cell was 0.55 +/- 0.05 nS (n = 7), and the critical Gc that allowed entrainment when the atrial cell was directly paced at a basic cycle length of 300 ms was 0.32 +/- 0.01 nS (n = 7). For each atrial cell we found periodic phenomena of synchronization other than 1:1 entrainment when Gc was between 0.1 and 0.3 nS, below the value required for frequency entrainment, when the atrial cell was directly driven at a basic cycle length of either 300 or 600 ms. In conclusion, the high input resistance of the atrial cells allows successful entrainment of nodal and atrial cells at low values of Gc, but further uncoupling produces arrhythmic interactions.

Modulation by extracellular ATP of L-type calcium channels in guinea-pig single sinoatrial nodal cell.

1. The effects of extracellular adenosine 5'-triphosphate ([ATP]zero) on the L-type Ca2+ channel currents in guinea-pig single sinoatrial nodal (SAN) cells, isolated by enzymatic dissociation, were investigated by use of whole-cell patch-clamp techniques. 2. The application of [ATP]zero (2 microM-1 mM) produced an inhibitory effect on the L-type Ca2+ channel current peak amplitude (10 mM Ba2+ as charge carrier) in a concentration-dependent and reversible manner with an IC50 of 100 microM and a Hill coefficient of 1.83. 3. The presence of the adenosine receptor antagonists, 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, 0.1 microM) and 8-phenyltheophylline (10 microM) did not affect the [ATP]zero-induced inhibition of the Ca2+ channel currents. Adenosine (100 microM) had little effect on the basal Ca2+ channel currents. Adenosine 500 microM, caused 23% inhibition of the Ca2+ channel current, which was abolished by 0.1 microM DPCPX. 4. The presence of the P2-purinoceptor antagonists, suramin (1, 10 and 100 microM), reactive blue 2 (1 and 10 microM) and pyridoxal-phosphate-6-azophenyl-2',4'-disulphonic acid (PPADS, 50 and 100 microM) failed to affect the inhibitory action of [ATP]zero on Ca2+ channel currents. 5. The relative rank order of potency of different nucleotides and nucleosides, at a concentration of 100 microM, on the inhibition of the Ca2+ channel currents is as follows: adenosine 5'-triphosphate (ATP) = alpha,beta-methylene-ATP (alpha,beta MeATP) > > 2-methylthioATP (2-MeSATP) > or = adenosine 5'-O-(3-thiotriphosphate) (ATP gamma S) > > uridine 5'-triphosphate (UTP) = adenosine 5'-diphosphate (ADP) > adenosine 5'-monophosphate (AMP) > or = adenosine. 6. These results suggest that [ATP]zero may play an important role in the heart beat by inhibiting the L-type Ca2+ channel currents in single SAN cells. This inhibitory effect is not due to the formation of adenosine resulting from the enzymatic degradation of [ATP]zero. Based on the relative order of inhibitory potency of different nucleotides and nucleosides on the L-type Ca2+ channel currents and the ineffectiveness of the purinoceptor antagonists tested, a novel type of purinoceptor may be involved.

Modulation of pacemaker activity of sinoatrial node cells by electrical load imposed by an atrial cell model.

To investigate the electrotonic modulation of sinoatrial (SA) node pacemaker activity by atrial muscle, single or multiple (2-7) SA node cells isolated from rabbit hearts were connected to a membrane model [resistance-capacitance (R-C) circuit] of an atrial cell through an external circuit that mimics the gap junctional conductance (Gc) between cells. When Gc was 0 nS (uncoupled conditions), all the preparations generated regular and stable spontaneous action potentials with a mean cycle length (SCL) of 263 +/- 45 ms (+/- SD, n = 35). Step increases of Gc were associated with a progressive prolongation of SCL. At sufficiently high values of Gc, the spontaneous activity became irregular and finally stopped. We defined the threshold Gc causing an appreciable SCL irregularity as the minimum Gc at which the ratio of SD to mean of SCL was > 0.3. The threshold Gc for a single SA node cell was calculated to be 0.58 nS. In the presence of acetylcholine (ACh; 0.05-0.2 microM), the coupling-induced inhibition of spontaneous activity was greatly increased, and the threshold Gc for a single SA node cell was decreased in a concentration-dependent manner. These findings show that the pacemaker activity of SA node cells is easily inhibited when the cells are coupled to a passive atrial cell model and the inhibition is amplified by ACh. Computer simulation using a modified Oxsoft HEART model indicates that the passive atrial cell model acts as a current sink, imposing a substantial outward current on the SA node cell, and ACh amplifies the effect by activating an additional outward current.