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2014 ; 114
(9
): 1410-21
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Optical mapping of sarcoplasmic reticulum Ca2+ in the intact heart: ryanodine
receptor refractoriness during alternans and fibrillation
#MMPMID24568740
Wang L
; Myles RC
; De Jesus NM
; Ohlendorf AK
; Bers DM
; Ripplinger CM
Circ Res
2014[Apr]; 114
(9
): 1410-21
PMID24568740
show ga
RATIONALE: Sarcoplasmic reticulum (SR) Ca(2+) cycling is key to normal
excitation-contraction coupling but may also contribute to pathological cardiac
alternans and arrhythmia. OBJECTIVE: To measure intra-SR free [Ca(2+)]
([Ca(2+)]SR) changes in intact hearts during alternans and ventricular
fibrillation (VF). METHODS AND RESULTS: Simultaneous optical mapping of Vm (with
RH237) and [Ca(2+)]SR (with Fluo-5N AM) was performed in Langendorff-perfused
rabbit hearts. Alternans and VF were induced by rapid pacing. SR Ca(2+) and
action potential duration (APD) alternans occurred in-phase, but SR Ca(2+)
alternans emerged first as cycle length was progressively reduced (217±10 versus
190±13 ms; P<0.05). Ryanodine receptor (RyR) refractoriness played a key role in
the onset of SR Ca(2+) alternans, with SR Ca(2+) release alternans routinely
occurring without changes in diastolic [Ca(2+)]SR. Sensitizing RyR with caffeine
(200 ?mol/L) significantly reduced the pacing threshold for both SR Ca(2+) and
APD alternans (188±15 and 173±12 ms; P<0.05 versus baseline). Caffeine also
reduced the magnitude of spatially discordant SR Ca(2+) alternans, but not APD
alternans, the pacing threshold for discordance, or threshold for VF. During VF,
[Ca(2+)]SR was high, but RyR remained nearly continuously refractory, resulting
in minimal SR Ca(2+) release throughout VF. CONCLUSIONS: In intact hearts, RyR
refractoriness initiates SR Ca(2+) release alternans that can be amplified by
diastolic [Ca(2+)]SR alternans and lead to APD alternans. Sensitizing RyR
suppresses spatially concordant but not discordant SR Ca(2+) and APD alternans.
Despite increased [Ca(2+)]SR during VF, SR Ca(2+) release was nearly continuously
refractory. This novel method provides insight into SR Ca(2+) handling during
cardiac alternans and arrhythmia.