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An Angiotensin Receptor Blocker Prevents Arrhythmogenic Left Atrial Remodeling in a Rat Post Myocardial Infarction Induced Heart Failure Model

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An Angiotensin Receptor Blocker Prevents Arrhythmogenic Left Atrial Remodeling in a Rat Post Myocardial Infarction Induced Heart Failure Model ORIGINAL ARTICLE Cardiovascular Disorders http://dx.doi.org/10.3346/jkms.2013.28.5.700 • J Korean Med Sci 2013; 28: 700-708 An Angiotensin Receptor Blocker Prevents Arrhythmogenic Left Atrial Remodeling in a Rat Post Myocardial Infarction Induced Heart Failure Model Hyun-Su Kim, Chi-Wan No, This study investigated the role of angiotensin II receptor blocker in atrial remodeling in Sang-Ho Goo, and Tae-Joon Cha rats with atrial fibrillation (AF) induced by a myocardial infarction (MI). MIs were induced by a ligation of the left anterior descending coronary artery. Two days after, the rats in the Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, losartan group were given losartan (10 mg/kg/day for 10 weeks). Ten weeks later, Korea echocardiography and AF induction studies were conducted. Ejection fraction was significantly lower in the MI rats. Fibrosis analysis revealed much increased left atrial Received: 19 April 2012 fibrosis in the MI group than sham (2.22 ± 0.66% vs 0.25 ± 0.08%, P = 0.001) and Accepted: 1 April 2013 suppression in the losartan group (0.90 ± 0.27%, P = 0.001) compared with the MI group. ± ± Address for Correspondence: AF inducibility was higher in the MI group than sham (39.4 43.0% vs 2.0 6.3%, Tae-Joon Cha, MD P = 0.005) and significantly lower in losartan group (12.0 ± 31.6%, P = 0.029) compared Division of Cardiology, Department of Internal Medicine, Kosin with the MI. The left atrial endothelial nitric oxide synthase (NOS) and sarco/endoplasmic University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 2+ 602-702, Korea reticulum Ca -ATPase levels were lower in the MI group and higher in the losartan group Tel: +82.51-990-3422, Fax: +82.51-990-3047 significantly. The atrial inducible NOS and sodium-calcium exchanger levels were higher in E-mail: [email protected] the MI and lower in the losartan group significantly. Losartan disrupts collagen fiber formation and prevents the alteration of the tissue eNOS and iNOS levels, which prevent subsequent AF induction. Key Words: Atrial Fibrillation; Heart Failure; Fibrosis; Angiotensin Receptor Blocker INTRODUCTION dog model of ventricular tachypacing (VTP) induced HF, treat- ment with inhibitors of angiotensin-converting enzyme de- The increasing incidence of heart failure (HF) and the aging of creased the duration of AF via interfering with fibrosis forma- the population have led to an increased incidence of atrial fi- tion induced by the activation of mitogen-activated protein ki- brillation (AF). AF is a commonly occurring arrhythmia, pres- nases (MAPKs) (11). An increased angiotensin II action has ent in people older than age 65 yr. The Framingham Heart Study been implicated in endothelial dysfunction characterized by a reported that the lifetime risk for the development of AF is 1 in 4 alternation of PKG signaling pathway and decreased nitric ox- for men and women aged 40 yr and older (1). AF is a major ide (NO) availability (12). Increased expression of endothelial cause of morbidity and mortality, and increases the risk for nitric oxide synthase (eNOS) was identified in the myocardial death (2, 3), congestive heart failure (CHF) (2), and embolic endothelium of atrium in patients treated with an angiotensin- phenomena including strokes (2, 4). Among several causes of converting enzyme inhibitor (13). AF, CHF is one of the most important causes. CHF is an increas- In the Losartan Intervention For Endpoint Reduction in Hy- ingly frequent cardiovascular disorder that affects 15-20 million pertension (LIFE) study, treatment with losartan resulted in a people worldwide. In the Framingham experience, CHF in- decreased incidence of atrial fibrillation and stroke (10). Howev- crease the risk of AF 4.5-fold in men and 5.9-fold in women (5). er, the exact mechanism for the anti-arrhythmic effects of ARBs Both AF and CHF are linked to an increased activation of the is unknown, especially as related to effects on the NO system. renin-angiotensin system, which has been related to myocardi- Recently, several studies have demonstrated a relationship be- al fibrosis in hypertensive heart disease (6), CHF, myocardial tween AF and nitric oxide synthase (NOS). For example, Shiro- infarction (MI) (7), and cardiomyopathy (8). shita-Takeshita et al. (14) showed a relationship between eNOS Angiotensin II receptor blockers (ARBs) have been reported and AF in a dog atrial tachycardia model. Cai et al. (15) found to decrease the formation of ventricular fibrosis in rat models that endocardial NOS expression and NO production were de- (9) and to decrease the incidence of AF in humans (10). In a creased in a pig model of AF. The angiotensin II levels are in- © 2013 The Korean Academy of Medical Sciences. pISSN 1011-8934 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. eISSN 1598-6357 Kim H-S, et al. • Angiotensin Receptor Blockers Prevent Left Atrial Remodeling creased in CHF and angiotensin II is an important regulator of coronary ligation. The perioperative mortality was around 40% CHF induced arrhythmogenesis (16). Therefore, there could be in the rats submitted to the coronary artery ligation. a relationship between the angiotensin II modulating NO sys- tem and the arrhythmogenesis in CHF. The aim of this study was Echocardiogram to evaluate these relationships by examining ARB responses. At the end of the study, the rats were lightly anesthetized with Atrial fibrosis is a major contributing factor to AF according an intraperitoneal injection of ketamine (25 mg/kg) with xyla- to the findings of large animal and human studies (17, 18). How- zine (5 mg/kg). Transthoracic echocardiography was perform- ever, the relationship between the fibrosis and AF has rarely ed using a 12-MHz phased-array probe (Acuson Sequoia C512; been investigated in small animal models and the effects of Mountain View, CA, USA). The wall thickness and LV diameters several calcium regulatory proteins are still disputed. Recently, during diastole and systole were measured from the M-mode the animal models for in vivo study of acute AF have been limit- recordings according to the leading-edge method. Two dimen- edly available in large animals (e.g., dogs, pigs or sheep), which sional short-axis images at the mid-papillary muscle level were cannot be easily studied in most laboratories. However, the in- obtained for the measurement of the LV end-diastolic dimen- duction of AF was recently demonstrated by atrial burst pacing sion (LVEDD), LV end-systolic dimension (LVESD), fractional in animals as small as mice (19). Therefore, this study also eval- shortening (FS), and wall thickness. The ejection fraction (EF) uated the correlation between fibrosis and AF, and between an- was calculated as follows: EF = (D2-S2)/D2 × 100, where S was giotensin II and NOS, in a rat atrial fibrosis model created by the systolic and D the diastolic dimension (expressed in cm). post myocardial infarction induced heart failure. The antiar- The left atrial and aortic diameters were measured from the M- rhythmic effects of ARBs and the relationship between angio- mode recordings in a modified parasternal long axis view. tensin II modulation of NOS and several arrhythomogenic pathways were also explored. Electrophysiological study On the open chest study days, the rats were anesthetized with MATERIALS AND METHODS ketamine (90 mg/kg) and xylazine (13 mg/kg) and ventilated mechanically. The AF induction was performed in an open- Animals and preparation chest state, with a bipolar lead attached to the right atrial ap- All animal-handling procedures were approved by the institu- pendage. Bipolar hook electrode was made by 2 Bipac unipolar tional animal care and use committee of the Kosin University 26-gauge needle electrodes 37 mm TP-EL450, (Biopac, Inc., School of Medicine, which followed the guidelines of the Kore- Santa Barbara, CA, USA). AF was induced by right atrial burst an Council on Animal Care. Male Sprague-Dawley (SD, Dae- pacing (using 4 times current of the pacing threshold for 30 sec- han Biolink Inc. Eumseong, Korea) rats (n = 30), aged 7 to 8 onds at 600 bpm). AF was induced ten times if the AF duration weeks and weighing 250 to 300 g, were fed a normal sodium was ≤ 20 min, and five times if the AF lasted between 20 and 30 diet, and offered tap water. MI was induced by a ligation of the min. AF that lasted more than 30 min was considered to be per- left anterior descending coronary artery. Two days after induc- sistent. Persistent AF was counted as 30 min duration. The mean tion of the MI, the rats were randomized into 2 groups: an un- duration of AF in each rat was determined on the basis of 10 in- treated MI group (n = 10) and a MI+Losartan group (n = 10) ductions. that received losartan at 10 mg/kg/day for 10 weeks. The drug was added to the drinking water and water consumption and Quantification of fibrosis body weight were carefully monitored for the entire 10-week After the completion of the electrophysiological study, the heart treatment. Sham operated rats served as a control (n = 10). was rapidly removed and weighed and the heart to body weight ratio was calculated. The hearts were immersed in a 10% buff- Creating the MI rat models ered formalin solution and then embedded in paraffin. Masson MIs were induced in the SD rats after ligation of the left anterior trichrome staining was used to characterize the collagen fibers.
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