Introduction: Myocardial ischemia is associated with gap junctional (GJ) uncoupling and slow conduction velocity (CV). Preserving GJ coupling attenuates CV slowing during metabolic ischemia. We hypothesized that preserving ephaptic coupling (EpC)-an alternate form of electrical coupling between cardiac myocytes, can also attenuate CV slowing during metabolic ischemia (aglycemia, hypoxia,
... [Show full abstract] acidosis-pH 6.5).Methods: Hearts were perfused for 15 mins (Control) with various solutions of high and low [Ca2+]o and [Na+]o (2-1.25mM and 153-146mM, respectively) before 30 mins of ischemia and then reperfused for 20 mins. CV and APD were determined by optical mapping. Electron microscopy was performed to determine perinexal width (WP).Results: Solution A - high [Ca2+]o and low [Na+]o was associated with CV slowing (29% of control) but no arrhythmias, and APD prolongation during ischemia. Increasing [Na+]o (Solution B) was associated with increased arrhythmias during ischemia (CV could not be measured) with no change in APD. However, decreasing [Ca2+]o and increasing [Na+]o (Solution C) attenuated CV slowing (18% of control) and abolished arrhythmias during ischemia with no APD prolongation. To determine the effect of [Ca2+]o on CV slowing and arrhythmias, hearts were perfused with either solution D (Solution B + Mannitol) or Solution E (moderate [Ca2+]o=1.6mM and high [Na+]o). Solutions D and E attenuated CV slowing (18 and 19% of control respectively) while Solution D reduced arrhythmias as well. Additionally, ischemia increased WP during Solution D or E perfusion relative to control. Comparing between solutions in this study, Solution C performs the best during ischemia.Conclusions: Together, these data suggest that perfusate ion fluctuations that do not significantly impact CV and arrhythmias during control conditions have significant effect during ischemia. Additionally, preventing perinexal collapse and preserving EpC during ischemia attenuates arrhythmogenic CV slowing.