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1 Pharmacology, Osaka University, Suita, Osaka, Japan
2 Pharmacology, Osaka University, Suita, Osaka, Japan; Suita, Osaka, Japan
3 Pharmacology, Osaka University, Suita, Osaka, Japan; The Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Osaka, Japan; Suita, Osaka, Japan
* To whom correspondence should be addressed. E-mail: ykurachi{at}pharma2.med.osaka-u.ac.jp.
IKr-blockers prolong the action potential duration (APD) in a reverse frequency-dependent manner and may induce arrhythmias including torsades des pointes in the ventricle. Meanwhile, the IKr-blocker dofetilide has been authorized for treating atrial arrhythmias including fibrillation. There are, however, a limited number of studies on the action of IKr-blockers on atrial action potential. When we tested a mathematical model of the human atrial action potential (Courtemanche et al. 1998) to examine the effects of dofetilide-type IKr-blockade, this model could not reproduce the reverse-frequent nature of IKr-blockade on atrial APD. Accordingly, we modified the model by introducing a slow IKs activation parameter. In this case, as the slow time constant was increased dofetilide-type blockade induced more prominent reverse frequency-dependent APD elongation. Using the modified model, we also examined the effects of two more types of IKr-blockade similar to those of quinidine and vesnarinone. Both drugs show voltage- and time-dependent block of IKr though the onset of inhibition by quinidine is much faster than that of vesnarinone. When we incorporated the kinetics of the effects of these drugs on IKr into the model, we found that quinidine-type blockade caused a reverse frequency-dependent elongation of APD which was similar to the effect of dofetilide-type, while vesnarinone-type did not. This coincides with experimental observations. The lack of the reverse frequency-dependence in vesnarinone-type blockade was accounted for by the slow development of IKr-blockade at depolarized potentials. These results suggest that voltage- and time-dependence of IKr-blockade by drugs may be critical for the phenotype of drug-effect on atrial action potential.
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