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1 Departments of Medicine, Institutes of Basic Sciences, Colleges of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan - Republic of China; the Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
2 Department of Physiology, Institutes of Basic Sciences, Colleges of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan - Republic of China
3 Departments of Engineering, Institutes of Electrical Engineering, Tainan, Taiwan, Taiwan - Republic of China
* To whom correspondence should be addressed. E-mail: rsung{at}mail.ncku.edu.tw.
Patients with Andersen-Tawil syndrome (ATS) mostly have mutations on the KCNJ2
gene producing loss of function or dominant-negative suppression of the inward
rectifier K+ channel Kir2.1. However, clinical manifestations of ATS including
dysmorphic features, periodic paralysis (hypo-, hyper-, or normokalemic), long QT,
and ventricular arrhythmias (VA) are considerably variable. Using a modified
dynamic Luo-Rudy simulation model of cardiac ventricular myocyte, we elucidate the
mechanisms of VA in ATS. We adopted a kinetic model of KCNJ2 in which channel
block by Mg+2 and spermine was incorporated. In this study, we attempt to examine
the effects of KCNJ2 mutations on the ventricular action potential (AP),
single-channel Markovian models were reformulated and incorporated into the
dynamic Luo-Rudy model for rapidly and slowly delayed rectifying K+ currents and
KCNJ2 channel. During pacing at 1.0 Hz with [K+]o at 5.4 mM, a stepwise 10%
reduction of Kir2.1 channel conductance progressively prolonged the terminal
repolarization phase of AP along with gradual depolarization of the resting membrane
potential (RMP). At 90% reduction, early after-depolarizations (EADs) became
inducible and RMP was depolarized to -55.0 mV (control: -90.1 mV) followed by
emergence of spontaneous action potentials (SAP). Both EADs and SAP were
facilitated by a decrease in [K+]o and suppressed by increase in [K+]o.
-adrenergic
stimulation enhanced delayed after-depolarizations (DADs) and could also facilitate
EADs as well as SAP in the setting of low [K+]o and reduced Kir2.1 channel
conductance. In conclusion, the spectrum of VA in ATS includes (1) triggered activity
mediated by EADs and/or DADs, and (2) abnormal automaticity manifested as SAP.
These VA can be aggravated by a decrease in [K+]o and
-adrenergic stimulation, and
may potentially induce torsades de pointes and cause sudden death. In patients with
ATS, the hypokalemic form of periodic paralysis should have the highest propensity
to VA especially during physical activities.
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