Suppression of spontaneous ca elevations prevents atrial fibrillation in calsequestrin 2-null hearts.
BACKGROUND
Atrial fibrillation (AF) risk has been associated with leaky ryanodine receptor 2 (RyR2) Ca release channels. Patients with mutations in RyR2 or in the sarcoplasmic reticulum Ca-binding protein calsequestrin 2 (Casq2) display an increased risk for AF. Here, we examine the underlying mechanisms of AF associated with loss of Casq2 and test mechanism-based drug therapy.


RESULTS
Compared with wild-type Casq2+/+ mice, atrial burst pacing consistently induced atrial flutter or AF in Casq2-/- mice and in isolated Casq2-/- hearts. Atrial optical voltage maps obtained from isolated hearts revealed multiple independent activation sites arising predominantly from the pulmonary vein region. Ca and voltage mapping demonstrated diastolic subthreshold spontaneous Ca elevations (SCaEs) and delayed afterdepolarizations whenever the pacing train failed to induce AF. The dual RyR2 and Na channel inhibitor R-propafenone (3 μmol/L) significantly reduced frequency and amplitude of SCaEs and delayed afterdepolarizations in atrial myocytes and intact atria and prevented induction of AF. In contrast, the S-enantiomer of propafenone, an equipotent Na channel blocker but much weaker RyR2 inhibitor, did not reduce SCaEs and delayed afterdepolarizations and failed to prevent AF.


CONCLUSIONS
Loss of Casq2 increases risk of AF by promoting regional SCaEs and delayed afterdepolarizations in atrial tissue, which can be prevented by RyR2 inhibition with R-propafenone. Targeting AF caused by leaky RyR2 Ca channels with R-propafenone may be a more mechanism-based approach to treating this common arrhythmia.
Division of Clinical Pharmacology, Department of Medicine, Division of Cardiology, Department of Medicine, Department of Biomedical Engineering and Physics, and Division of Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, TN; and Department of Cardiovascular Diseases, University of Pisa, Pisa, Italy.
Michela
M
Faggioni
Eleonora
E
Savio-Galimberti
Raghav
R
Venkataraman
Hyun Seok
HS
Hwang
Prince J
PJ
Kannankeril
Dawood
D
Darbar
Björn C
BC
Knollmann
D000818:Animals; D001281:Atrial Fibrillation / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control*; D002118:Calcium / Q000378:metabolism*; D002155:Calsequestrin / Q000378:metabolism*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004195:Disease Models, Animal; D051379:Mice; D018345:Mice, Knockout; D032342:Muscle Cells / Q000378:metabolism* / Q000473:pathology; D011405:Propafenone / Q000627:therapeutic use*; D016896:Treatment Outcome; D061567:Voltage-Gated Sodium Channel Blockers / Q000627:therapeutic use
D002155:Calsequestrin; D061567:Voltage-Gated Sodium Channel Blockers; C514388:casq2 protein, mouse; D011405:Propafenone; D002118:Calcium
atrial fibrillation; calsequestrin 2; delayed afterdepolarization; propafenone; ryanodine receptor calcium release channel; tachycardia, ventricular