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1 Cardiovascular Research Center RIH and Brown Medical School
2 Rhode Island Hospital
3 University of Freiburg
4 Pennsylvania State University College of Medicine
* To whom correspondence should be addressed. E-mail: gideon_koren{at}brown.edu.
Anesthetic agents prolong cardiac repolarization by blocking ion currents. However, the clinical relevance of this blockade in subjects with reduced repolarization reserve is unknown. We have generated transgenic LQT1 and LQT2 rabbits that lack IKs or IKr currents, and used them as a model system to detect the channel-blocking properties of anesthetic agents. Therefore, LQT1, LQT2, and littermate control (LMC) rabbits were administered isoflurane, thiopental, midazolam, propofol, or ketamine, and surface ECGs were analyzed. Genotype-specific heart rate correction formulae were used to determine the expected QT interval at a given heart rate. The QT index (QTi) was calculated as percentage of the observed QT/expected QT. Isoflurane, a drug that blocks IKs, prolonged the QTi only in LQT2 and LMC but not in LQT1 rabbits. Midazolam, which blocks IK1, prolonged the QTi in both LQT1 and LQT2 but not in LMC. Thiopental, which blocks both IKs and IK1, increased the QTi in LQT2 and LMC more than in LQT1. By contrast, ketamine, which does not block IKr, IKs, or IK1, did not alter the QTi in any group. Finally, anesthesia with isoflurane or propofol resulted in lethal polymorphic ventricular tachycardia (pVT) in three out of nine LQT2 rabbits. Conclusion: Transgenic LQT1 and LQT2 rabbits could serve as an in vivo model in which to examine the pharmacogenomics of drug-induced QT-prolongation of anesthetic agents and their pro-arrhythmic potential. Transgenic LQT2 rabbits developed pVT under isoflurane and propofol, underlining the pro-arrhythmic risk of IKs blockers in subjects with reduced IKr.
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