The initiation of the heart beat.
During a normal lifetime, the heart may beat over 2 billion times, but the mechanisms by which the heart beats are initiated remain a subject of intense investigation. Since the discovery of a pacemaker current (I(f)) in 1978, multiple studies have shown that rhythmic changes in membrane voltage (the "membrane voltage clock") underlie the mechanisms of automaticity. The I(f) is a depolarization current activated during hyperpolarization. Therefore, when the cardiac cells recover, the I(f) is activated and slowly depolarizes the cell membrane, leading to the onset of action potential. Recent studies, however, suggest that increased intracellular Ca (Ca(i)) induced by spontaneous rhythmic sarcoplasmic reticulum Ca release (the "calcium clock") is also jointly responsible for the initiation of the heart beat. Elevated Ca(i) activates another ionic current (the sodium-calcium exchanger current or I(NCX)), leading to spontaneous phase 4 depolarization. Under normal conditions, both clocks are needed to initiate the heart beat. Malfunction of the clocks is associated with sinus node dysfunction in heart failure and atrial fibrillation. More studies are needed to determine how both clocks work together to initiate heart beat under normal and disease conditions.
Chen
Peng-Sheng
PS
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. chenpp@iupui.edu
Joung
Boyoung
B
Shinohara
Tetsuji
T
Das
Mithilesh
M
Chen
Zhenhui
Z
Lin
Shien-Fong
SF
D000200:Action Potentials; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000378:metabolism / Q000503:physiopathology; D001683:Biological Clocks; D020013:Calcium Signaling; D056966:Excitation Contraction Coupling; D006329:Heart Conduction System / Q000378:metabolism* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D007700:Kinetics; D009200:Myocardial Contraction; D012849:Sinoatrial Node / Q000378:metabolism; D019831:Sodium-Calcium Exchanger / Q000378:metabolism
D019831:Sodium-Calcium Exchanger