Arrhythmic effects of norepinephrine in a model of cardiac ischemia and reperfusion.

The aim of this study was to assess the direct effects of norepinephrine on mechanisms of arrhythmia induced by conditions of ischemia followed by reperfusion. Isolated canine Purkinje fiber-papillary muscle preparations were studied using standard microelectrode techniques. Tissues were superfused for 40 min with a solution simulating "ischemia" (i.e., hypoxic, acidotic, elevated lactate, and zero substrate) and then "reperfused" for 60 min. Ischemia produced a moderate loss of membrane potential in both tissues. Reperfusion resulted in rapid polarization of the tissues, which was accompanied by oscillatory afterpotentials and aftercontractions in 6 of 12 and 4 of 12 Purkinje fibers, respectively. This was followed by a progressive loss of membrane potential and inexcitability in Purkinje fibers. Recovery was associated with activity resembling depolarization-induced automaticity in 4 of 12 fibers. Addition of norepinephrine (0.5 microM) to the ischemic and reperfusion solutions altered primarily the reperfusion responses. Oscillatory afterpotentials and aftercontractions were larger and occurred in 8 of 8 and 6 of 8 Purkinje fibers, respectively. Norepinephrine also prevented or blunted the progressive depolarization to inexcitability in Purkinje tissues and increased automaticity occurring at low (depolarization-induced automaticity) and more polarized membrane potentials (enhanced normal pacemaker activity). This study demonstrates that norepinephrine exacerbates several potential mechanisms of arrhythmia elicited by reperfusion in canine Purkinje tissues.