L-type calcium current recovery versus ventricular repolarization: preserved membrane-stabilizing mechanism for different QT intervals across species.
BACKGROUND
Long QT syndrome is associated with early after-depolarization (EAD) that may result in torsade de pointes (TdP). Interestingly, the corrected QT interval seems to be proportional to body mass across species under physiologic conditions.


OBJECTIVE
The purpose of this study was to test whether recovery of L-type calcium current (I(Ca,L)), the primary charge carrier for EADs, from its inactivated state matches ventricular repolarization time and whether impairment of this relationship leads to development of EAD and TdP.


METHODS
Transmembrane action potentials from the epicardium, endocardium, or subendocardium were recorded simultaneously with a transmural ECG in arterially perfused left ventricular wedges isolated from cow, dog, rabbit, and guinea pig hearts. I(Ca,L) recovery was examined using action potential stimulation in isolated left ventricular myocytes.


RESULTS
The ventricular repolarization time (action potential duration at 90% repolarization [APD(90)]), ranging from 194.7 +/- 1.8 ms in guinea pig to 370.2 +/- 9.9 ms in cows, was linearly related to the thickness of the left ventricular wall among the species studied. The time constants (tau) of I(Ca,L) recovery were proportional to APD(90), making the ratios of tau to APD(90) fall into a relatively narrow range among these species despite markedly different ventricular repolarization time. Drugs with risk for TdP in humans were shown to impair this intrinsic balance by either prolongation of the repolarization time and/or acceleration of I(Ca,L) recovery, leading to the appearance of EADs capable of initiating TdP.


CONCLUSIONS
An adequate balance between I(Ca,L) recovery and ventricular repolarization serves as a "physiologic stabilizer" of ventricular action potentials in repolarization phases.
Guo
Donglin
D
Main Line Health Heart Center, Wynnewood, Pennsylvania 19096, USA.
Zhou
Jun
J
Zhao
Xiaojing
X
Gupta
Prasad
P
Kowey
Peter R
PR
Martin
Jack
J
Wu
Ying
Y
Liu
Tengxian
T
Yan
Gan-Xin
GX
D000200:Action Potentials; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D020746:Calcium Channels, L-Type; D002417:Cattle; D004285:Dogs; D006168:Guinea Pigs; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology; D008564:Membrane Potentials; D032342:Muscle Cells; D011817:Rabbits; D013045:Species Specificity; D016171:Torsades de Pointes / Q000503:physiopathology
D020746:Calcium Channels, L-Type