Background:
Clinical and experimental data on the cardiac effects of
acute hypernatremia are scarce and inconsistent. We aimed to determine and
understand the effects of different levels of acute hypernatremia on the human
ventricular action potential.
Methods:
We performed computer simulations
using two different, very comprehensive models of the electrical activity of a
single human ventricular cardiomyocyte,
i.e.
, the Tomek–Rodriguez model
following the O’Hara–Rudy dynamic (ORd) model and the
Bartolucci–Passini–Severi model as published in 2020 (known as the ToR-ORd and
BPS2020 models, respectively). Mild to extreme levels of hypernatremia were
introduced into each model based on experimental data on the effects of
hypernatremia on cell volume and individual ion currents.
Results:
In
both models, we observed an increase in the intracellular sodium and potassium
concentrations, an increase in the peak amplitude of the intracellular calcium
concentration, a hyperpolarization of the resting membrane potential, a
prolongation of the action potential, an increase in the maximum upstroke
velocity, and an increase in the threshold stimulus current at all levels of
hypernatremia and all stimulus rates tested. The magnitude of all of these
effects was relatively small in the case of mild to severe hypernatremia but
substantial in the case of extreme hypernatremia. The effects on the action
potential were related to an increase in the sodium–potassium pump current, an
increase in the sodium–calcium exchange current, a decrease in the rapid and
slow delayed rectifier potassium currents, and an increase in the fast and late
sodium currents.
Conclusions:
The effects of mild to severe
hypernatremia on the electrical activity of human ventricular cardiomyocytes are
relatively small. In the case of extreme hypernatremia, the effects are more
pronounced, especially regarding the increase in threshold stimulus current.