Increasing Calcium-activated Potassium Current Shortens and Stabilizes Repolarization in Chronic Heart Failure

Heart failure (HF) is a chronic disease resulting in abnormal prolongation and instability of ventricular repolarization. IKCa has been suggested to stabilize repolarization in HF as IKca blockade has shown pro-arrhythmic effects in the failing ventricle. We tested the hypothesis that an SK channel (IKCa) agonist CyPPA, would shorten and stabilize ventricular repolarization in HF ventricular myocytes. Methods: A tachypacing - induced 4 month HF canine model was used (LVFS: 15.9 ± 2.5%), and LV midwall myocytes were isolated and compared to normal controls. Action potential duration at 50 (APD50), and 90% (APD90) repolarization and APD instability (beat to beat variability of repolarization, a measure of arrhythmia risk) were measured before and after the application of CyPPA (0.001nM-20uM) in control ventricular, and in 4 months HF ventricular myocytes (n=10-15 per group). Results: In control myocytes, CyPPA shortened action potential APD50 and APD90 in a concentration dependent manner (0.001nM-20uM, p<0.05 vs baseline at 20uM, Figure). In HF myocytes, CyPPA also shortened APD50 and APD90, but at lower concentrations than in controls. Notably, In addition to APD shortening, CyPPA significantly decreased repolarization instability (P<0.05 vs baseline at 1 Hz) in HF. CyPPA did not affect resting membrane potential in either group. Conclusions: HF myocytes are more sensitive to IKCa agonism than control myocytes. An IKCa agonist attenuates electrophysiologic remodeling and stabilizes repolarization in failing ventricular myocytes, suggesting a therapeutic role for this approach in HF.