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1.  Modulation of Transmural Repolarization 
Ventricular myocardium in larger mammals has been shown to be comprised of three distinct cell types: epicardial, M, and endocardial. Epicardial and M cell action potentials differ from endocardial cells with respect to the morphology of phase 1. These cells possess a prominent Ito-mediated notch responsible for the “spike and dome” morphology of the epicardial and M cell response. M cells are distinguished from the other cell types in that they display a smaller IKs, but a larger late INa and INa-Ca. These ionic distinctions underlie the longer action potential duration (APD) and steeper APD-rate relationship of the M cell. Difference in the time course of repolarization of phase 1 and phase 3 are responsible for the inscription of the electrocardiographic J wave and T wave, respectively. These repolarization gradients are sensitively modulated by electrotonic communication among the three cells types, [K +]o, and the presence of drugs that either reduce or augment net repolarizing current. A reduction in net repolarizing current generally leads to a preferential prolongation of the M cell action potential, responsible for a prolongation of the QT interval and an increase in transmural dispersion of repolarization (TDR), which underlies the development of torsade de pointes arrhythmias. An increase in net repolarizing current can lead to a preferential abbreviation of the action potential of epicardium in the right ventricle (RV), and endocardium in the left ventricle (LV). These actions also lead to a TDR that manifests as the Brugada syndrome in RV and the short QT syndrome in LV.
doi:10.1196/annals.1341.028
PMCID: PMC1474840  PMID: 16093507
Brugada syndrome; cardiac heterogeneity; electrocardiogram; long QT syndrome; M cell; short QT syndrome
2.  Cellular Basis for the Repolarization Waves of the ECG 
One hundred years after Willem Einthoven first recorded the electrocardiogram (ECG), physicians and scientists are still debating the cellular basis for the various waves of the ECG. In this review, our focus is on the cellular basis for the J, T, and U waves of the ECG. The J wave and T wave are thought to arise as a consequence of voltage gradients that develop as a result of the electrical heterogeneities that exist within the ventricular myocardium. The presence of a prominent action potential notch in epicardium but not endocardium gives rise to a voltage gradient during ventricular activation that inscribes the J wave. Transmural and apico-basal voltage gradients developing as a result of difference in the time course of repolarization of the epicardial, M, and endocardial cell action potentials, and the more positive plateau potential of the M cell contribute to inscription of the T wave. Amplification of these heterogeneities results in abnormalities of the J wave and T wave, leading to the development of the Brugada, long QT, and short QT syndromes. The basis for the U wave has long been a matter of debate. One theory attributes the U wave to mechanoelectrical feedback. A second theory ascribes it to voltage gradients within ventricular myocardium and a third to voltage gradients between the ventricular myocardium and the His–Purkinje system. Although direct evidence in support of any of these three hypotheses is lacking, recent studies involving the short QT syndrome have generated renewed interest in the mechanoelectrical hypothesis.
doi:10.1196/annals.1380.021
PMCID: PMC1952680  PMID: 17132789
heterogeneity; arrhythmias; electrophysiology; long QT; short QT; Brugada syndrome

Results 1-2 (2)