A Fatal Case of Massive Verapamil Overdose: An Overview of the Treatment Options

Atemnkeng, Francis; Shabani, Jawad; Chen, Lu; Gala, Bhavesh; Ramalho, Jonathan; Diaz, Keith; Nfonoyim, Jay

doi:10.14740/jmc3763

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…Dofetilide prolongs QT interval and is associated with high TdP risk ( Jaiswal and Goldbarg, 2014 ; Ibrahim et al., 2021 ). Verapamil is an L-type Ca 2+ channel blocker and is considered safe with no TdP risk according to CredibleMeds; however, Verapamil poisoning can cause symptoms such as hypotension, AV block and bradycardia ( Hofer et al., 1993 ; Barrow et al., 1994 ; Atemnkeng et al., 2021 ).…”

Section: Methodsmentioning

confidence: 99%

The importance of mechanical conditions in the testing of excitation abnormalities in a population of electro-mechanical models of human ventricular cardiomyocytes

et al. 2023

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Background: Populations of in silico electrophysiological models of human cardiomyocytes represent natural variability in cell activity and are thoroughly calibrated and validated using experimental data from the human heart. The models have been shown to predict the effects of drugs and their pro-arrhythmic risks. However, excitation and contraction are known to be tightly coupled in the myocardium, with mechanical loads and stretching affecting both mechanics and excitation through mechanisms of mechano-calcium-electrical feedback. However, these couplings are not currently a focus of populations of cell models.Aim: We investigated the role of cardiomyocyte mechanical activity under different mechanical conditions in the generation, calibration, and validation of a population of electro-mechanical models of human cardiomyocytes.Methods: To generate a population, we assumed 11 input parameters of ionic currents and calcium dynamics in our recently developed TP + M model as varying within a wide range. A History matching algorithm was used to generate a non-implausible parameter space by calibrating the action potential and calcium transient biomarkers against experimental data and rejecting models with excitation abnormalities. The population was further calibrated using experimental data on human myocardial force characteristics and mechanical tests involving variations in preload and afterload. Models that passed the mechanical tests were validated with additional experimental data, including the effects of drugs with high or low pro-arrhythmic risk.Results: More than 10% of the models calibrated on electrophysiological data failed mechanical tests and were rejected from the population due to excitation abnormalities at reduced preload or afterload for cell contraction. The final population of accepted models yielded action potential, calcium transient, and force/shortening outputs consistent with experimental data. In agreement with experimental and clinical data, the models demonstrated a high frequency of excitation abnormalities in simulations of Dofetilide action on the ionic currents, in contrast to Verapamil. However, Verapamil showed a high frequency of failed contractions at high concentrations.Conclusion: Our results highlight the importance of considering mechanoelectric coupling in silico cardiomyocyte models. Mechanical tests allow a more thorough assessment of the effects of interventions on cardiac function, including drug testing.

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