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Division of Cardiovascular Diseases, Departments of Internal Medicine, Molecular Pharmacology, and Experimental Therapeutics, Mayo Clinic and Foundation, Rochester, Minnesota 55905
The failing ventricular
myocardium is characterized by reduction of high-energy phosphates and
reduced activity of the phosphotransfer enzymes creatine kinase (CK)
and adenylate kinase (AK), which are responsible for transfer of
high-energy phosphoryls from sites of production to sites of
utilization, thereby compromising excitation-contraction coupling. In
humans with chronic atrial fibrillation (AF) unassociated with
congestive heart failure (CHF), impairment of atrial myofibrillar energetics linked to oxidative modification of myofibrillar CK has been
observed. However, the bioenergetic status of the failing atrial
myocardium and its potential contribution to atrial electrical instability in CHF have not been determined. Dogs with
(n = 6) and without (n = 6) rapid
pacing-induced CHF underwent echocardiography (conscious) and
electrophysiological (under anesthesia) studies. CHF dogs had more
pronounced mitral regurgitation, higher atrial pressure, larger atrial
area, and increased atrial fibrosis. An enhanced propensity to sustain
AF was observed in CHF, despite significant increases in atrial
effective refractory period and wavelength. Profound deficits in atrial
bioenergetics were present with reduced activities of the
phosphotransfer enzymes CK and AK, depletion of high-energy phosphates
(ATP and creatine phosphate), and reduction of cellular energetic
potential (ATP-to-ADP and creatine phosphate-to-Cr ratios). AF duration
correlated with left atrial area (r = 0.73, P = 0.01) and inversely with atrial ATP concentration
(r =
0.75, P = 0.005), CK activity
(r =
0.57, P = 0.054), and AK
activity (r =
0.64, P = 0.02). Atrial
levels of malondialdehyde, a marker of oxidative stress, were
significantly increased in CHF. Myocardial bioenergetic deficits are a
conserved feature of dysfunctional atrial and ventricular myocardium in CHF and may constitute a component of the substrate for AF in CHF.
heart failure; atrium; fibrillation; electrophysiology; metabolism
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