Amiodarone (AMD) is a widely used antiarrhythmic drug with high efficacy for treating atrial fibrillation and tachycardia. The pharmacologic profile of AMD is complex. Although AMD is classified as a class III antiarrhythmic drug, it possesses biophysical characteristics of class I, II, and IV agents. Despite its adverse side-effects, AMD remains the most commonly prescribed antiarrhythmic drug. AMD was described to prolong the QT interval and can lead to torsades de pointes (TdP). The metabolism of AMD takes place using CYP3A4 and CYP2C8. Full metabolism of AMD produces 22 phase I and 11 phase II metabolites, the most prominent of which is produced through an N-deethylation reaction by CYP3A4, giving rise to pharmacologically active N-Desethylamiodarone (DES). We sought to study the effects of AMD on peak and late sodium currents (INaP and INaL, and determine whether these effects change as AMD metabolizes into DES. We hypothesized AMD and DES blocks both INaP and INaL with similar profiles due to their structural similarities. As such, given the inherent small amounts of INa in Nav1.5, we used the Long QT-3-causing mutation, ΔKPQ, to better detect any drug-mediated decrease in INa. We found neither AMD nor DES affects conductance in WT or ΔKPQ channels; however, both drugs hyperpolarize steady-state fast-inactivation, with larger shifts in ΔKPQ than WT-Nav1.5, in a compound- and concentration-specific manner. INaP is significantly blocked by both compounds in ΔKPQ compared to minimal block in WT-Nav1.5. AMD increases window currents and INaL in WT Nav1.5, and decreases these in ΔKPQ, whereas DES increases both window and INaL in both WT and ΔKPQ. We conclude the proarrhythmic effects of AMD may be due to both its effects, and the effects of at least one of its metabolites, on sodium channels.
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