Nicorandil attenuates both temporal and spatial repolarization alternans

T-wave alternans (TWA) on the electrocardiogram have been frequently associated with long QT syndrome (LQTS) and abrupt rate change. The present study investigated the effect of the potassium channel opener nicorandil on the repolarization alternans at the endocardium and the epicardium in the left ventricle. Electrocardiogram and transmural monophasic action potentials from the endocardium and the epicardium were simultaneously recorded in Langendorff-perfused guinea pig hearts. The hearts were paced at a basic cycle length (BCL) of 240 ms and the cycle length (CL) was abruptly shortened to 170 ms to induce repolarization alternans. Disopyramide and nicorandil were used to increase or attenuate repolarization alternans, respectively. Repolarization alternans were numerically expressed as the sum of the absolute difference between consecutive monophasic action potential durations at 90% repolarization (MAPD90) in the first 10 beats. In the control hearts, the MAPD90 alternans were 78.6 ± 14.9 ms at the endocardium, and 49.8 ± 58 ms at the epicardium (P =.03 endocardium vs epicardium). Disopyramide (2 μg/mL) increased the MAPD90 alternans to 186.6 ± 30.6 ms at the endocardium and 116.4 ± 16.5 ms at the epicardium, and enhanced the difference of repolarization alternans between the endocardium and the epicardium (transmural dispersion) from 28.8 ± 11.3 ms to 70.2 ± 18.7 ms (P =.02 vs controls). Nicorandil (400 ng/mL) suppressed the MAPD90 alternans to 79.6 ± 16.3 ms at the endocardium and 56.0 ± 11.8 ms at the epicardium, and attenuated the transmural dispersion to 23.6 ± 6.0 ms (P =.02 vs disopyramide-administrated hearts). Our results suggest that nicorandil attenuates both temporal (beat-to-beat) and spatial (between the endocardium and the epicardium) repolarization alternans induced by the combination of cycle length changes and disopyramide administration.