Early afterdepolarizations in cardiac action potentials as mixed mode oscillations due to a folded node singularity

PLoS One. 2018 Dec 31;13(12):e0209498. doi: 10.1371/journal.pone.0209498. eCollection 2018.

Abstract

Early afterdepolarizations (EADs) are pathological voltage oscillations during the repolarization phase of cardiac action potentials. They are considered as potential precursors to cardiac arrhythmias and have recently gained much attention in the context of preclinical drug safety testing under the Comprehensive in vitro Proarrhythmia Assay (CiPA) paradigm. From the viewpoint of multiple time scales theory, the onset of EADs has previously been studied by means of mathematical action potential models with one slow ion channel gating variable. In this article, we for the first time associate EADs with mixed mode oscillations in dynamical systems with two slow gating variables and present a folded node singularity of the slow flow as a novel mechanism for EADs genesis. We derive regions of the pharmacology parameter space in which EADs occur using both the folded node analysis and a full system bifurcation analysis, and we suggest the normal distance to the boundary of the EADs region as a mechanism-based risk metric to computationally estimate a drug's proarrhythmic liability.

MeSH terms

  • Action Potentials / drug effects
  • Action Potentials / physiology*
  • Animals
  • Arrhythmias, Cardiac / drug therapy
  • Arrhythmias, Cardiac / physiopathology*
  • Calcium / metabolism
  • Computer Simulation
  • Heart Conduction System / drug effects
  • Heart Conduction System / physiopathology
  • Heart Ventricles / drug effects
  • Heart Ventricles / physiopathology*
  • Humans
  • Models, Cardiovascular*
  • Models, Theoretical
  • Myocytes, Cardiac / drug effects
  • Myocytes, Cardiac / pathology
  • Neuromuscular Depolarizing Agents / chemistry
  • Neuromuscular Depolarizing Agents / therapeutic use

Substances

  • Neuromuscular Depolarizing Agents
  • Calcium

Grants and funding

The author(s) received no specific funding for this work.