IntroductionThe hyperpolarization-activated 'funny current' (If), also known as 'pacemaker current', is a key player in sinoatrial node (SAN) pacemaker activity. This (mainly) inward current of mixed ionic nature is a determinant of the spontaneous depolarization that underlies SAN pacemaker activity and thus a modulator of pacing rate [1,2]. The If channel is constituted by four hyperpolarization-activated, cyclic-nucleotide-gated (HCN) subunits, with the HCN4 protein, which is encoded by the HCN4 gene, as the dominant HCN isoform in rabbit and human .Since 2003, several loss-of-function mutations in the HCN4 gene have been associated with human sinus bradycardia [7,8]. For example, Milanesi et al. [9] reported on an Italian family with the S672R mutation. Average resting heart rate (mean ± SEM) was 52.2 ± 1.4 beats/min (range 43-60 beats/min) in the 15 mutation carriers vs. 73.2 ± 1.6 beats/min (range 64-81 beats/min) in the 12 non-affected family members. Similarly, Nof et al. [10] reported on a family with the G480R mutation. The average heart rate of the 8 mutation carriers was 48 ± 12 beats/min, whereas that of the 8 non-carriers was 73 ± 11 beats/min. In three families of Moroccan Jewish decent, Laish-Farkash et al. [11] observed an average heart rate of 58 ± 6 beats/min in 14 carriers of the A485V mutation and 77±12 beats/min in 6 non-carriers.Only recently, Baruscotti et al.[12] reported on a gainof-function mutation in HCN4. Five family members and carriers of this R524Q mutation exhibited inappropriate sinus tachycardia rather than bradycardia, with a daytime heart rate of 98.5 ± 14.2 beats/min (mean ± SD) in the proband.The S672R, G480R, and A485V loss-of-function mutations in HCN4 reduce resting heart rate by ≈30%, whereas the R524Q gain-of-function mutation increases it substantially. Voltage-clamp experiments on HCN4 channels expressed in cell lines have revealed changes in the expression and kinetics of these and other mutant channels [13,14], but the functional effects of these changes on SAN pacemaker activity remain unresolved.In the present study, we attempted to assess the effects of HCN4 mutations on SAN pacemaker activity by incorporating the experimentally identified changes in expression and kinetics of HCN4 channels, conducting If, in the most recent comprehensive mathematical models of single SAN cells. These are the models by Maltsev and Lakatta [15] ('Maltsev-Lakatta model') and Severi et al.[16] ('Severi-DiFrancesco model'). Both models represent the electrophysiological behavior of a single isolated 32-pF rabbit SAN cell and are based on the large amount of experimental data that have become available over the years, largely obtained in patch-clamp experiments on isolated rabbit SAN cells.