Huang Christopher L-H
Physiological Laboratory and the Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom.
Physiol Rev. 2017 Jan;97(1):283-409. doi: 10.1152/physrev.00007.2016.
Cardiac arrhythmias can follow disruption of the normal cellular electrophysiological processes underlying excitable activity and their tissue propagation as coherent wavefronts from the primary sinoatrial node pacemaker, through the atria, conducting structures and ventricular myocardium. These physiological events are driven by interacting, voltage-dependent, processes of activation, inactivation, and recovery in the ion channels present in cardiomyocyte membranes. Generation and conduction of these events are further modulated by intracellular Ca homeostasis, and metabolic and structural change. This review describes experimental studies on murine models for known clinical arrhythmic conditions in which these mechanisms were modified by genetic, physiological, or pharmacological manipulation. These exemplars yielded molecular, physiological, and structural phenotypes often directly translatable to their corresponding clinical conditions, which could be investigated at the molecular, cellular, tissue, organ, and whole animal levels. Arrhythmogenesis could be explored during normal pacing activity, regular stimulation, following imposed extra-stimuli, or during progressively incremented steady pacing frequencies. Arrhythmic substrate was identified with temporal and spatial functional heterogeneities predisposing to reentrant excitation phenomena. These could arise from abnormalities in cardiac pacing function, tissue electrical connectivity, and cellular excitation and recovery. Triggering events during or following recovery from action potential excitation could thereby lead to sustained arrhythmia. These surface membrane processes were modified by alterations in cellular Ca homeostasis and energetics, as well as cellular and tissue structural change. Study of murine systems thus offers major insights into both our understanding of normal cardiac activity and its propagation, and their relationship to mechanisms generating clinical arrhythmias.
心脏心律失常可能继发于正常细胞电生理过程的破坏,这些过程是可兴奋活动及其组织传播的基础,表现为从主要的窦房结起搏器发出的连贯波阵面,通过心房、传导结构和心室心肌进行传播。这些生理事件由心肌细胞膜中存在的离子通道的相互作用、电压依赖性的激活、失活和恢复过程驱动。这些事件的产生和传导还受到细胞内钙稳态、代谢和结构变化的进一步调节。本综述描述了针对已知临床心律失常情况的小鼠模型的实验研究,其中这些机制通过基因、生理或药理学操作进行了改变。这些范例产生了分子、生理和结构表型,这些表型通常可直接转化为相应的临床情况,并且可以在分子、细胞、组织、器官和全动物水平上进行研究。心律失常的发生可以在正常起搏活动、规律刺激、施加额外刺激后或在逐渐增加的稳定起搏频率期间进行探索。心律失常的基质通过易引发折返性兴奋现象的时间和空间功能异质性来识别。这些可能源于心脏起搏功能、组织电连接性以及细胞兴奋和恢复方面的异常。动作电位兴奋期间或恢复后发生的触发事件可能会导致持续性心律失常。这些表面膜过程会因细胞钙稳态和能量代谢的改变以及细胞和组织结构的变化而受到影响。因此,对小鼠系统的研究为我们理解正常心脏活动及其传播以及它们与临床心律失常发生机制的关系提供了重要的见解。