By Eleanor H. Bennington
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Additional info for Horizons in World Cardiovascular Research, Volume 3
These findings, however, are at odds with results of other clinical studies. Narayan et al. (2007a) reported that the mean maximum slope values, and the range of diastolic intervals over which the slope is greater than 1, are similar in heart failure patients and control subjects with no structural heart disease. In the study-group, the slope values were the same in patients with and without inducible arrhythmia. , 2007a). , 2005). , 2005). , 1996b) are quite flat (less than 1), thus raising a possibility that increased propensity to VF in cardiac disease may be related to restitution-independent mechanisms.
Taken together, these changes account for abbreviation of ventricular action potential following a premature excitation (Boyett and Jewell, 1980). Apart from INa, ICa, and IK, APD restitution may rely on recovery of Ito and INa-Ca. Inward Currents (INa and ICa) De Hemptinne (1971) used voltage-clamp technique to show for the first time that in frog auricular fibers, the amplitude of inward current elicited by second depolarizing pulse decreases when the time interval between the first and the second pulse is shorter than 600 ms.
More recently, the contribution of these factors to APD shortening upon abrupt reduction in cycle length has been reviewed by Carmeliet (2004). Incomplete Recovery of Ionic Currents A premature depolarization recruits less inward currents due to incomplete recovery of INa and ICa from inactivation caused by previous excitation. Furthermore, due to slow time decay of outward K+ currents contributing to ventricular repolarization, an extrastimulus applied shortly after previous regular beat activates more IKr and IKs.