The Role of Altered Calcium-Handling in Mechanically-Induced
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THE ROLE OF ALTERED CALCIUM-HANDLING IN MECHANICALLY-INDUCED ARRHYTHMIAS DURING ACUTE REGIONAL ISCHEMIA by Peter A.R. Baumeister Submitted in partial fulfillment of requirements for the degree of Master of Science at Dalhousie University Halifax, Nova Scotia May 2016 Copyright by Peter A.R. Baumeister, 2016 TABLE OF CONTENTS LIST OF FIGURES ............................................................................................................ vi ABSTRACT .................................................................................................................. viii LIST OF ABBREVIATIONS USED ................................................................................. ix ACKNOWLEDGEMENTS ................................................................................................ xi CHAPTER 1: Introduction .................................................................................................. 1 1.1 Sudden Cardiac Death and Acute Regional Ischemia .............................................. 1 1.2 Conditions for Arrhythmogenesis ............................................................................ 3 1.2.I Abnormal Automaticity ........................................................................................ 3 1.2.II Triggered Activity - Afterdepolarizations........................................................... 5 1.2.III Reentrant Activity .............................................................................................. 9 1.2.IV Conclusion ....................................................................................................... 11 1.3 Phase IA Ischemia .................................................................................................. 12 1.3.I Increased Extracellular Potassium...................................................................... 12 1.3.II Hypoxia/Anoxia ................................................................................................ 17 1.3.III Conclusion ....................................................................................................... 21 1.4 Phase IB Ischemia .................................................................................................. 24 1.4.I Gap Junction Uncoupling ................................................................................... 24 1.4.II Endocardial Discharge ...................................................................................... 27 1.4.III Catecholamine Release .................................................................................... 29 1.4.IV Altered Mechanics ........................................................................................... 35 ii 1.4.V Conclusion ........................................................................................................ 42 CHAPTER 2: Methods ...................................................................................................... 44 2.1 Rabbit Isolated Heart Model .................................................................................. 44 2.2 Reagents ................................................................................................................. 46 2.2.I Krebs-Henseleit Solution ................................................................................... 46 2.2.II Voltage Sensitive Dye: di-4-ANBDQPQ ......................................................... 47 2.2.III Calcium Indicator: Rhod-2 AM ....................................................................... 47 2.2.IV Electro-mechanical Uncoupler: Blebbistatin ................................................... 48 2.2.V Calcium Buffer: BAPTA AM ........................................................................... 48 2.2.VI Ryanodine Receptor Stabilizers: JTV-519 and Dantrolene Sodium ............... 49 2.3 Optical Mapping ..................................................................................................... 49 2.3.I Mono-Parametric ................................................................................................ 50 2.3.II Dual-Parametric ................................................................................................ 50 2.4 Procedures .............................................................................................................. 53 2.4.I Acute Regional Ischemia.................................................................................... 55 2.4.II Mechanically-Independent Alterations in Calcium Handling .......................... 57 2.4.III Mechanically-Dependent Alterations in Calcium Handling............................ 58 2.4.IV Effect of Calcium Buffering on Arrhythmogenesis ........................................ 58 2.4.V Effect of RyR Stabilization on Arrhythmogenesis ........................................... 59 2.5 Data Analysis ......................................................................................................... 59 iii 2.5.I Non-Perfused Area Analysis .............................................................................. 59 2.5.II Hemodynamic Analysis .................................................................................... 61 2.5.III Arrhythmia Analysis ........................................................................................ 61 2.5.IV Optical Mapping Analysis ............................................................................... 64 CHAPTER 3: Results ........................................................................................................ 67 3.1 Mechanically-Independent Alterations in Calcium Handling ................................ 67 3.1.I Effect of Increasing Rhod-2 Volume on Fluorescence ...................................... 67 3.1.II Ischemia-Induced Alterations in Intracellular Calcium Handling .................... 69 3.1.III Effect of Electro-Mechanical Uncoupling on Arrhythmogenesis ................... 80 3.2 Mechanically Dependent Alterations in Calcium Handling .................................. 82 3.3 Effect of Calcium Buffering on Arrhythmogenesis ............................................... 84 3.3.I The Effect of BAPTA on Arrhythmogenesis ..................................................... 84 3.4 Effect of RyR Stabilization on Arrhythmogenesis ................................................. 86 3.4.I Effect of RyR Stabilizers on Tissue Electrophysiology ..................................... 86 3.4.II Effect of RyR Stabilization on Arrhythmogenesis ........................................... 88 3.5 Phase Analysis of Previously Reported Arrhythmia Incidence during ARI .......... 90 3.6 Non-Perfused Area and Hemodynamic Group Comparisons ................................ 92 CHAPTER 4: Discussion .................................................................................................. 98 4.1 Mechanically-independent, Ischemia-induced Changes in Calcium Handling ..... 98 4.2 Mechanical Effects on Calcium Handling ........................................................... 105 iv 4.3 Confirmation of the Effects of Cytosolic Calcium Buffering on Arrhythmia Incidence .............................................................................................................. 109 4.4 The Effects of RyR Stabilization on the Incidence of Arrhythmias .................... 112 CHAPTER 5: Conclusion and Future Directions ............................................................ 116 REFERENCES ................................................................................................................ 119 APPENDIX .................................................................................................................. 143 v LIST OF FIGURES Figure 1.1 Examples of Early and Delayed Afterdepolarizations ....................................... 7 Figure 1.2 Changes in Extracellular Potassium During Acute Regional Ischemia ........... 14 Figure 1.3 Changes in High Energy Substrates and pH During Acute Global Ischemia .. 18 Figure 1.4 Changes in Action Potential Morphology During Ischemia ............................ 23 Figure 1.5 Changes in Cell-Cell Coupling During Acute Regional Ischemia ................... 26 Figure 1.6 Changes in Effluent Catecholamine Concentration During Ischemia .............. 31 Figure 1.7 The Importance of Ventricular Load in Arrhythmogenesis during Acute Regional Ischemia in Swine ............................................................................ 37 Figure 1.8 Importance of Mechanics during Acute Regional Ischemia in Isolated Rabbit Hearts .............................................................................................................. 39 Figure 2.1 Schematic of Dual-Parametric Optical Mapping.............................................. 52 Figure 2.2 Experimental Design. ....................................................................................... 54 Figure 2.3 Acute Regional Ischemia in a Langendorff-Perfused Rabbit Isolated Heart. .. 56 Figure 2.4 Example Quantification of Non-Perfused Area (NPA). ................................... 60 Figure 2.5 Example of Arrhythmia Classification ............................................................. 63 Figure 2.6 Representative Ischemic Zone and Regions of Interest (ROIs) ....................... 66 Figure 3.1 Determination of Optimal Rhod-2 Volume ...................................................... 68 Figure 3.2 Qualitative Changes in Voltage and Calcium Transient Morphologies ........... 70 Figure 3.3 Alterations in the dFV/dtmax and dFCa/dtmax during