Sudden cardiac death is largely attributable to sudden onset ventricular arrhythmias. Alterations in cardiac conduction, particularly the slowing of conduction velocity is one major factor in arrhythmogenesis. By understanding the mechanisms and factors that modulate cardiac conduction velocity, we can assess and perhaps mitigate the risk of arrhythmia in patients for whom slowed conduction is a arrhythmogenic substrate. Cardiac conduction has traditionally been described by cable theory, which predicts an inverse relationship between extracellular resistance and conduction velocity (CV). However, in studies that reduce extracellular resistance by inducing interstitial edema, there are conflicting results, with some labs showing increased CV when edema is induced with one agent, and others showing reduced CV when edema is induced with a different agent. In the first part of this dissertation, we present experimental data in support of ephaptic coupling (EpC), a theorized mechanism of conduction that resolves these apparent contradictions. In the later part of this dissertation, we address how changes in sodium concentration can alter conduction, despite conventional wisdom suggesting that it should not. We show that when sodium channels are impaired, such as by genetic mutation or pharmacologic blockade, that conduction is sensitized to changes in sodium concentrations that would not otherwise induce changes in CV. We go on to explore the mechanisms that modulate this sensitivity and present data that show it is a function of both EpC and outward potassium currents. Taken together, these data expand our understanding of the mechanics behind cardiac conduction and demonstrate that EpC has a clinically relevant impact on conduction and represents a new pathway to explore in regard to the treatment and management of arrhythmogenic and conduction disorders. / Doctor of Philosophy / In all large animals, life is sustained by the regular coordinated beating of the heart to pump blood throughout the body. Throughout this continuous activity, and even with minute-to-minute changes in heart rate, this electrically driven activity continues without major disruption. Until it doesn't. Major arrhythmias can occur suddenly, and without warning. Over the last century, we have begun to understand some of the reasons why heart, even an injured one, will work normally for hundreds of thousands of beats, and on the next fall into a life-threatening new pattern, and one of the most important of these reasons is the speed of conduction: the spread of electrical activation throughout the heart tissue. Understanding the mechanisms of conduction provides a way to assess and mitigate the risk of arrhythmias and may open up new avenues for treatment and prevention. This dissertation presents evidence for a previously theoretical mechanism of conduction called ephaptic coupling. We show that this electric field mediated form of conduction can be modulated with clinically used osmotic agents, and that it has a physiologically relevant impact on conduction. We also show that hyponatremia (i.e. low sodium), a condition that is traditionally thought to have minimal impact on cardiac conduction, because a significant modulator of conduction when sodium channel functions are impaired. As a great many drugs block sodium channels, this sensitization to hyponatremia and the factors that mediate it are underappreciated concerns that are relevant to a wide array of patients.
The new findings presented in this dissertation advance our collective understanding of the mechanisms of cardiac conduction and provide evidence for new avenues of exploration in the prevention and management of arrhythmias and conduction disorders.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/119281 |
| Date | 04 June 2024 |
| Creators | Adams, William Patrick |
| Contributors | Graduate School, Poelzing, Steven, Gourdie, Robert G., Lahmers, Sunshine M., Swanger, Sharon Ann |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Language | English |
| Detected Language | English |
| Type | Dissertation |
| Format | ETD, application/pdf |
| Rights | Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International, http://creativecommons.org/licenses/by-nc-sa/4.0/ |
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