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. METHODS AND 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.
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. METHODS AND 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.
Authors: H K Kroemer; C Funck-Brentano; D J Silberstein; A J Wood; M Eichelbaum; R L Woosley; D M Roden Journal: Circulation Date: 1989-05 Impact factor: 29.690
Authors: John A Vest; Xander H T Wehrens; Steven R Reiken; Stephan E Lehnart; Dobromir Dobrev; Parag Chandra; Peter Danilo; Ursula Ravens; Michael R Rosen; Andrew R Marks Journal: Circulation Date: 2005-04-26 Impact factor: 29.690
Authors: Paolo Alboni; Giovanni L Botto; Nicola Baldi; Mario Luzi; Vitantonio Russo; Lorella Gianfranchi; Paola Marchi; Massimo Calzolari; Alberto Solano; Raffaele Baroffio; Germano Gaggioli Journal: N Engl J Med Date: 2004-12-02 Impact factor: 91.245
Authors: Donald M Lloyd-Jones; Thomas J Wang; Eric P Leip; Martin G Larson; Daniel Levy; Ramachandran S Vasan; Ralph B D'Agostino; Joseph M Massaro; Alexa Beiser; Philip A Wolf; Emelia J Benjamin Journal: Circulation Date: 2004-08-16 Impact factor: 29.690
Authors: Silvia G Priori; Carlo Napolitano; Mirella Memmi; Barbara Colombi; Fabrizio Drago; Maurizio Gasparini; Luciano DeSimone; Fernando Coltorti; Raffaella Bloise; Roberto Keegan; Fernando E S Cruz Filho; Gabriele Vignati; Abraham Benatar; Angelica DeLogu Journal: Circulation Date: 2002-07-02 Impact factor: 29.690
Authors: Qing Lou; Andriy E Belevych; Przemysław B Radwański; Bin Liu; Anuradha Kalyanasundaram; Bjorn C Knollmann; Vadim V Fedorov; Sándor Györke Journal: J Physiol Date: 2014-12-02 Impact factor: 5.182