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Am J Physiol Heart Circ Physiol (January 25, 2008). doi:10.1152/ajpheart.01233.2007
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Submitted on October 23, 2007
Accepted on January 21, 2008

Spatially Discordant Alternans in Cardiomyocyte Monolayers

Carlos De Diego1, Rakesh K. Pai2, Amish S Dave3, Adam Lynch2, Mya Thu2, Fuhua Chen4, Lai-Hua Xie5, James N. Weiss6*, and Miguel Valderrabano3

1 Cardiology, UCLA, Los Angeles, California, United States; , 3219 overland av, Los Angeles, California, 90034, United States
2 Cardiology, UCLA, Los Angeles, California, United States; Los Angeles, California, United States
3 Cardiology, UCLA, Los Angeles, California, United States
4 Dept of Pediatric Cardiology, UCLA School of Medicine, Los Angeles, California, United States
5 Cardiology, UCLA, Los Angeles, California, United States; Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
6 Cardiology, UCLA, Los Angeles, California, United States; Division of Cardiology, University of California School of Medicine, Los Angeles, California, United States

* To whom correspondence should be addressed. E-mail: jweiss{at}mednet.ucla.edu.

Repolarization alternans is a harbinger of sudden cardiac death, particularly when it becomes spatially discordant. Alternans, a beat-to-beat alternation in the action potential duration (APD) and intracellular Ca (Cai), can arise from either tissue heterogeneities or dynamic factors. Distinguishing between these mechanisms in normal cardiac tissue is difficult because of inherent complex three dimensional tissue heterogeneities. To evaluate repolarization alternans in a simpler two dimensional cardiac substrate, we optically recorded voltage and/or Cai in monolayers of cultured neonatal rat ventricular myocytes during rapid pacing, before and after exposure to BayK8644 to enhance dynamic factors promoting alternans. Under control conditions (n=37), rapid pacing caused detectable APD alternans in 81% of monolayers, and Cai transient alternans in all monolayers, becoming spatially discordant in 62%. After BayK8644 (n=28), CV restitution became more prominent and APD and Cai alternans developed and became spatially discordant in all monolayers, with an increased number of nodal lines separating out-of-phase alternating regions. Nodal lines moved closer to the pacing site with faster pacing rates, and changed orientation when the pacing site was moved, as predicted for the dynamically-generated, but not heterogeneity-based, alternans. Spatial APD gradients during spatially discordant alternans were sufficiently steep to induce conduction block and reentry. These findings indicate that spatially discordant alternans severe enough to initiate reentry can be readily induced by pacing in two dimensional cardiac tissue, and behaves according to predictions for a predominantly dynamically-generated mechanism.







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