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2 . 2022

Status of INavin atrial cardiomyocytes after administration of cardioplegia


Background. Cardioplegia plays an important role in cardiac surgery, providing myocardial protection and making it possible to perform open-heart surgery. Thereby in early postoperative period we have dealings with atrial fibrillation, that becomes a significant problem. Atrial fibrillation is one of the most common forms of cardiac rhythm disorder developing after cardiovascular surgery performed with the use of cardioplegia in patients with coronary artery disease. Atrial fibrillation develops in 30–50% of such cases. The pathogenesis of this complication is not fully understood, but its multifactorial nature is known. One of the most significant factors is electrolyte disorders associated with malfunctioning of the cardiomyocyte ion channels after the administration of cardioplegic solutions.

Aim. To study the effect of cardioplegia on changes in functions of the electrophysiological characteristics of INav ion channels in human atrial cardiomyocytes before and after administration  of a cardioplegic solution.

Material and methods. The study included 30 patients who underwent surgical coronary revascularization using with an intracellular cardioplegic solution. The study of INav was performed using the patch clamp electrophysiological method.

Results. When analyzing the electrophysiological curves obtained before and after the administration of cardioplegia, we found a decrease in the amplitude of the fast sodium current by 13% and a shift in the maximum by 12 mV after cardioplegia. From the activation curves we obtained the half-height and slope of the activation curve before and after administration of cardioplegia. The result indicates a change in the dynamics of INav activation and a decrease in the conduction velocity.

Conclusion. Our study demonstrated that, after cardioplegia, the amplitude of the fast sodium INav current decreases with a shift of the activation curve to the right. This fact suggests that some of the fast sodium channels are inactivated. Thus, the conduction velocity of cardiac impulse decreases by 1.47±0.1 times, which, in our opinion, is one of the important pathogenetic factors in the development of atrial fibrillation in the immediate postoperative period.

Keywords:cardioplegia; custodial; atrial fibrillation; cardiac arrhythmias; INav ion channels; cardiomyocytes; electrolyte disorders

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Shumakov D.V., Agladze K.I., Zybin D.I., Agafonov E.G., Popov M.A., Romanova S.G., Frolova Sh.R., Slotvitsky M.M., Berezhnoy A.K., Tsvelaya V.A. Status of INav in atrial cardiomyocytes after administration of cardioplegia. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (2): 26–32. DOI:  (in Russian)


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Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Medicine today

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