Inhibition of I_K,ACh current may contribute to clinical efficacy of class I and class III antiarrhythmic drugs in patients with atrial fibrillation

摘要

Inward rectifier potassium currents I_K1 and acetylcholine activated I_K,ACh are implicated in atrial fibrillation (AF) pathophysiology. In chronic AF (cAF), I_K,ACh develops a receptor-independent, constitutively active component that together with increased I_K1 is considered to support maintenance of AF. Here, we tested whether class I (propafenone, flecainide) and class III (dofetilide, AVE0118) antiarrhythmic drugs inhibit atrial I_K1 and I_K,ACh in patients with and without cAF. I_K1 and I_K,ACh were measured with voltage clamp technique in atrial myocytes from 58 sinus rhythm (SR) and 35 cAF patients. The M-receptor agonist carbachol (CCh; 2 µM) was employed to activate I_K,ACh. In SR, basal current was not affected by either drug indicating no effect of these compounds on I_K1. In contrast, all tested drugs inhibited CCh-activated I_K,ACh in a concentration-dependent manner. In cAF, basal current was confirmed to be larger than in SR (at −80 mV, −15.2 ± 1.2 pA/pF, n = 88/35 vs. −6.5 ± 0.4 pA/pF, n = 194/58 [myocytes/patients]; P < 0.05), whereas CCh-activated I_K,ACh was smaller (−4.1 ± 0.5 pA/pF vs. −9.5 ± 0.6 pA/pF; P < 0.05). In cAF, receptor-independent constitutive I_K,ACh contributes to increased basal current, which was reduced by flecainide and AVE0118 only. This may be due to inhibition of constitutively active I_K,ACh channels. In cAF, all tested drugs reduced CCh-activated I_K,ACh. We conclude that in cAF, flecainide and AVE0118 reduce receptor-independent, constitutively active I_K,ACh, suggesting that they may block I_K,ACh channels, whereas propafenone and dofetilide likely inhibit M-receptors. The efficacy of flecainide to terminate AF may in part result from blockade of I_K,ACh.