icatibant and Ventricular-Fibrillation

Brief reversible ischemic episodes (ischemic preconditioning, IPC) protect the heart against arrhythmias during a subsequent prolonged low-flow ischemia. We have recently shown that this protection involves release of bradykinin, activation of bradykinin B2 receptors followed by opening of sarcolemmal, but not mitochondrial ATP-sensitive K+ channels. The goal of this study was to clarify a trigger and/or mediator role of bradykinin in the antiarrhythmic effects of IPC during low-flow ischemia.. Isolated perfused rat hearts underwent 60 minutes of low-flow ischemia induced by reducing perfusion pressure followed by 60 minutes of reperfusion. Preconditioning was induced by 2 x 5 minutes episodes of zero-flow ischemia. In yet other groups, preconditioned or non-preconditioned hearts were treated either with bradykinin (10 nmol/L) or with HOE 140 (bradykinin B2 receptor antagonist, 100 nmol/L).. IPC reduced the number of ventricular premature beats, as well as the incidence of ventricular tachycardia and of ventricular fibrillation during low-flow ischemia. In addition, this protection was abolished by HOE 140 given during low-flow ischemia. Pharmacological preconditioning using short bradykinin perfusion instead of IPC did not show antiarrhythmic effects. However, bradykinin administered during low-flow ischemia and reperfusion reduced the number of ventricular premature beats and the incidence of ventricular tachycardia and of ventricular fibrillation during low-flow ischemia.. Bradykinin is a mediator, but unlikely a trigger, of antiarrhythmic effects of IPC during low-flow ischemia.

Topics: Animals; Bradykinin; Bradykinin Receptor Antagonists; Disease Models, Animal; Disease Progression; Electrocardiography; Heart Rate; Heart Ventricles; Ischemic Preconditioning, Myocardial; Male; Pilot Projects; Prognosis; Rats; Rats, Sprague-Dawley; Tachycardia, Ventricular; Ventricular Fibrillation

Aminopeptidase P and angiotensin-converting enzyme (ACE) are responsible for the metabolism of exogenously administered bradykinin in the coronary circulation of the rat. It has been shown that ACE inhibitors decrease cytosolic enzyme release from the ischemic rat heart and reduce reperfusion-induced ventricular arrhythmias by increasing endogenous levels of bradykinin. It was hypothesized that the aminopeptidase P inhibitor apstatin could do the same. In an isolated perfused rat heart preparation subjected to global ischemia and reperfusion, both apstatin and ramiprilat (an ACE inhibitor) significantly decreased creatine kinase (CK) and lactate dehydrogenase (LDH) release. The difference between the postischemia and preischemia levels of released CK was reduced 68% by apstatin and 68% by ramiprilat compared with control. The corresponding reductions in LDH release were 74% for apstatin and 81% for ramiprilat. A combination of the inhibitors was not significantly better than either one alone. Apstatin and ramiprilat also significantly reduced the duration of reperfusion-induced ventricular fibrillation by 69 and 61%, respectively. The antiarrhythmic effect of apstatin was reversed by HOE140, a bradykinin B2-receptor antagonist, suggesting that apstatin is acting by potentiating endogenously formed bradykinin. The results demonstrate that the aminopeptidase P inhibitor apstatin is cardioprotective in this model of cardiac ischemia/ reperfusion injury.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Animals; Arrhythmias, Cardiac; Bradykinin; Cardiovascular Agents; Creatine Kinase; Drug Interactions; In Vitro Techniques; L-Lactate Dehydrogenase; Male; Peptides; Perfusion; Protease Inhibitors; Ramipril; Rats; Rats, Sprague-Dawley; Reperfusion Injury; Ventricular Fibrillation

Recent studies have shown that bradykinin decreases the incidence of ischaemic arrhythmias in dogs and may also mediate the antiarrhythmic effects of preconditioning in this species. We investigated the effects of exogenously administered bradykinin on the severity of ischemic arrhythmias and the role of endogenously released bradykinin, acting on B2-receptors, in preconditioning in anaesthetized rats.. In protocol 1, male rats were subjected to a single 30 min occlusion of the left main coronary artery and received left ventricular infusions of bradykinin (30 ng to 10 micrograms/kg/min) or saline. In protocol 2, rats were pretreated with the B2-receptor antagonist HOE 140 (40 and 400 micrograms/kg intravenous bolus) 10 min before coronary artery occlusion. In protocol 3, rats were preconditioned by a 3 min coronary occlusion followed by 10 min of reperfusion before a sustained 30 min occlusion. Saline or HOE 140 was given 10 min before the preconditioning protocol. In all groups, the number and severity of ventricular arrhythmias were determined during the 30 min coronary occlusion.. In protocol 1, none of the doses of bradykinin had any significant effect on the total number of ventricular ectopic beats (1512 +/- 252 in saline-treated controls versus 1337 +/- 302 with the highest dose of bradykinin tested) or on the incidence of ventricular tachycardia or ventricular fibrillation. The two higher doses of bradykinin (1 and 10 micrograms kg/min) caused a reduction in blood pressure soon after infusion began, although this was not maintained for the duration of the experiment. In protocol 2, HOE 140, in doses that produced a sustained antagonism to the depressor response to bradykinin, had no effect on either arrhythmia count or the incidence of ventricular fibrillation in rats subjected to a single 30 min coronary occlusion. In protocol 3, a 3 min preconditioning occlusion in saline-treated rats reduced arrhythmia counts from 1046 +/- 196 in non-preconditioned rats to 76 +/- 44 in preconditioned rats, and reduced the incidences of ventricular tachycardia and ventricular fibrillation from 100 to 50% and from 75 to 7%, respectively. Neither dose of HOE 140 tested reversed these antiarrhythmic effects of preconditioning.. These results suggest that bradykinin is not protective against ischaemic arrhythmias in rats in vivo, whether given exogenously or released endogenously. Furthermore, in contrast to other species, bradykinin does not appear to play a role in the antiarrhythmic effect of ischaemic preconditioning.

Topics: Adrenergic beta-Antagonists; Animals; Arrhythmias, Cardiac; Blood Pressure; Bradykinin; Dose-Response Relationship, Drug; Heart Rate; Male; Myocardial Ischemia; Rats; Rats, Sprague-Dawley; Tachycardia, Ventricular; Ventricular Fibrillation