Refractory dispersion promotes conduction disturbance and arrhythmias in a Scn5a +/- mouse model

Abstract

Accentuated right ventricular (RV) gradients in action potential duration (APD) have been implicated in the arrhythmogenicity observed in Brugada syndrome in studies assuming that ventricular effective refractory periods (VERPs) vary in concert with APDs. The present experiments use a genetically modified mouse model to explore spatial heterogeneities in VERP that in turn might affect conduction velocity, thereby causing arrhythmias. Activation latencies, APDs and VERPs recorded during programmed S1S2 protocols were compared in RV and left ventricular (LV) epicardia and endocardia of Langendorff-perfused wild-type (WT) and Scn5a +/- hearts. Scn5a +/- and WT hearts showed similar patterns of shorter VERPs in RV than LV epicardia, and in epicardia than endocardia. However, Scn5a +/- hearts showed longer VERPs, despite shorter APD 90s, than WT in all regions examined. The pro- and anti-arrhythmic agents flecainide and quinidine increased regional VERPs despite respectively decreasing and increasing the corresponding APD 90s particularly in Scn5a +/- RV epicardia. In contrast, Scn5a +/- hearts showed greater VERP gradients between neighbouring regions, particularly RV transmural gradients, than WT (9. 1∈±∈1.1 vs. 5.7∈±∈0.5 ms, p∈