Drug-induced arrhythmia can occur under prolonged action potential duration (APD) due to block of IKr. Therefore, IKr block and APD prolongation have been used for predicting drug induced arrhythmia.However, IKr blockers have difference in risk for drug-induced arrhythmia. One of the reasons is that the occurrence of drug-induced arrhythmia under bradycardia is initiated by early afterdepolarization (EAD) at the repolarization phase in prolonged action potential. For example, terfenadine, which prolongs APD and cause EAD, is considered as a drug with a high risk for drug-induced arrhythmia. On the other hand, amiodarone, which prolongs APD but does not cause EAD in clinical practice, has been considered as a relatively safe antiarrhythmic drug. Therefore, there is a possibility that EAD occurrence can account for the difference in the risks among IKr blockers. To study the mechanisms underlying different occurrence of EAD, we examined the effects of voltage-dependent ICaL block property on EAD. In the present study, we used a mathematical model of human ventricular action potential. The results showed that amiodarone-like ICaL block model suppressed EAD. But, ICaL block models of terfenadine-like and bepridil-like increased EAD occurrence. The different effects on EAD were accounted for by difference in voltage-dependent block of ICaL, as weak ICaL block in hyperpolarized potential increased the occurrence of EAD. Therefore, to predict drug-induced arrhythmia, not only APD prolongation but also voltage-dependent property of ICaL block should be checked.

To: abstract pdf