Early afterdepolizations (EADs) induced by suppression of cardiac delayed rectifier
I
Kr and/or
I
Ks channels cause fatal ventricular tachyarrhythmias. In guinea pig ventricular myocytes, partial block of one of the channels
with complete block of the other reproducibly induced EADs. Complete block of both
I
Kr and
I
Ks channels depolarized the take-off potential and reduced the amplitude of EADs, which in some cases were not clearly separated
from the preceding action potentials. A selective L-type Ca
2+ (
I
Ca,L) channel blocker, nifedipine, effectively suppressed EADs at submicromolar concentrations. As examined with the action potential-clamp
method,
I
Ca,L channels mediated inward currents with a spike and dome shape during action potentials.
I
Ca,L currents decayed mainly due to inactivation in phase 2 and deactivation in phase 3 repolarization. When EADs were induced
by complete block of
I
Kr channels with partial block of
I
Ks channels, repolarization of the action potential prior to EAD take-off failed to increase
I
K1 currents and thus failed to completely deactivate
I
Ca,L channels, which reactivated and mediated inward currents during EADs. When both
I
Kr and
I
Ks channels were completely blocked,
I
Ca,L channels were not deactivated and mediated sustained inward currents until the end of EADs. Under this condition, the recovery
and reactivation of
I
Ca,L channels were absent before EADs. Therefore, an essential mechanism underlying EADs caused by suppression of the delayed
rectifiers is the failure to completely deactivate
I
Ca,L channels.
Keywords Early afterdepolarization -
I
Kr channel -
I
Ks channel - L-type Ca2+ channel - Long QT syndrome - Action potential clamp - Cardiac electrophysiology