If in left human atrium: a potential contributor to atrial ectopy

Objective : The left human atrium plays an important role in initiation of atrial fibrillation (AF) and the hyperpolarization activated cation current ( I f) is a candidate for contributing to abnormal automaticity. However, electrophysiological data concerning I f are not available in this cardiac region and we therefore investigated I f in human left atrial tissue. Methods : Human atrial myocytes were isolated from the left atrial appendage (LAA) and the left atrial wall (LAW) obtained from patients undergoing open heart surgery. I f was measured with the whole-cell patch-clamp technique. Results : I f densities between −70 and −110 mV were found to be significantly higher in LAA than in LAW cells. Furthermore, in the group of LAA cells the half maximal activation potential ( V 1/2) was found to be less negative ( V 1/2 of −84.3±1.9 mV, n =14/9) compared to LAW cells ( V 1/2 of −97.8±2.1 mV, n =28/9). Beta-adrenergic receptor stimulation with isoproterenol (1 μM) caused an acceleration of current activation and a V 1/2 shift to more positive potentials in cells of both regions (LAA: 8.8±2.3 mV, n =6/4 and LAW: 8.9±2.6 mV, n =6/4). Simulations using a mathematical model of the human atrial myocyte demonstrated that I f was able to induce spontaneous activity in the model at a regular rhythm due to the interplay of I f, Na+/Ca2+ exchange current and Ca2+ release of the sarcoplasmic reticulum (SR). Conclusions : Our study revealed the presence of I f in left atrial myocytes and showed that I f parameters depend on atrial region. I f current densities were sufficient to convert the mathematical model of a quiescent human atrial cell into a “pacemaker cell”. These data support the hypothesis of I f as a contributor to abnormal automaticity in human atrial tissue.