AVE0118, blocker of the transient outward current (I(to)) and ultrarapid delayed rectifier current (I(Kur)), fully restores atrial contractility after cardioversion of atrial fibrillation in the goat.
BACKGROUND
The loss of atrial contractile function after cardioversion of atrial fibrillation (AF) contributes to the thromboembolic risk associated with AF. The newly developed blocker of the transient outward current (I(to)) and ultrarapid delayed rectifier current (I(Kur)) AVE0118 prolongs atrial action potential duration and might therefore enhance atrial contractility. We compared the ability of AVE0118 to restore atrial contraction after cardioversion of AF with the efficacy of conventional positive inotropic compounds in the goat model of AF.


RESULTS
Eighteen goats were chronically instrumented with epicardial electrodes, a pressure transducer in the right atrium, and piezoelectric crystals to measure right atrial diameter. Atrial contractility and refractoriness and QT duration were measured before and after 1 week (3 to 8 days) of AF induced by repetitive burst pacing. The measurements were repeated after administration of digoxin (0.02 mg/kg), dobutamine (5 microg x kg(-1) x min(-1)), the Ca2+ sensitizer EMD57033 (1 mg x kg(-1) x min(-1)), the L-type Ca2+ channel agonist BayY5959 (0.1 mg x kg(-1) x min(-1)), and AVE0118 (0.01 to 0.2 mg x kg(-1) x min(-1)). The effect of AVE0118 on the configuration of atrial monophasic action potentials was determined for comparison. After 1 week of AF, atrial contractility during sinus rhythm or slow atrial pacing was reduced to <10%. Digoxin and dobutamine failed to increase atrial contractility. EMD57033 restored 41% and BayY5959 restored 48% of atrial contractility at baseline. BayY5959 significantly prolonged QT duration by 24.7%. AVE0118 enhanced atrial contraction to 156% of the baseline value. The positive inotropic effect was accompanied by a pronounced prolongation of atrial action potential duration and refractoriness, whereas QT duration remained unchanged.


CONCLUSIONS
Conventional positive inotropic drugs showed limited effect on atrial contractility after cardioversion of AF or produced QT prolongation. In contrast, the I(to)/I(Kur) blocker AVE0118 fully restored atrial contraction without proarrhythmic effects on the ventricle.
de Haan
Sunniva
S
Department of Physiology, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
Greiser
Maura
M
Harks
Erik
E
Blaauw
Yuri
Y
van Hunnik
Arne
A
Verheule
Sander
S
Allessie
Maurits
M
Schotten
Ulrich
U
D000200:Action Potentials / Q000187:drug effects / Q000502:physiology; D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D016280:Atrial Function, Right / Q000187:drug effects* / Q000502:physiology; D001713:Biphenyl Compounds / Q000494:pharmacology*; D002316:Cardiotonic Agents / Q000494:pharmacology; D051668:Delayed Rectifier Potassium Channels / Q000187:drug effects* / Q000502:physiology; D004077:Digoxin / Q000494:pharmacology; D004095:Dihydropyridines / Q000494:pharmacology; D004195:Disease Models, Animal; D004280:Dobutamine / Q000494:pharmacology; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D006041:Goats; D009200:Myocardial Contraction / Q000187:drug effects / Q000502:physiology; D026902:Potassium Channel Blockers / Q000494:pharmacology*; D024642:Potassium Channels, Voltage-Gated / Q000187:drug effects* / Q000502:physiology; D011804:Quinolines / Q000494:pharmacology; D013829:Thiadiazines / Q000494:pharmacology
C501729:AVE 0118; C109289:BAY y 5959; D001713:Biphenyl Compounds; D002316:Cardiotonic Agents; D051668:Delayed Rectifier Potassium Channels; D004095:Dihydropyridines; D026902:Potassium Channel Blockers; D024642:Potassium Channels, Voltage-Gated; D011804:Quinolines; D013829:Thiadiazines; C070609:EMD 53998; D004280:Dobutamine; D004077:Digoxin