Effects of simulated ischaemia on the electrical activity of ventricular myocardium in the presence of antiarrhythmic drugs.

The effects of a nutrient solution simulating the 'ischaemic milieu' (combined hyperkalaemia, hypoxia and acidosis) on the electrical activity of rabbit isolated ventricular myocardium were examined in the absence and presence of antiarrhythmic drugs. In such a simulated ischaemia the resting membrane potential, the rate of depolarization (Vmax) and the action potential duration (APD) were all diminished with a resultant decrease in conduction and a shortening of the effective refractory period (ERP). Sotalol, a Class 3 antiarrhythmic drug (5 x 10(-6)-10(-5) M/l) afforded a marked protection against the "ischaemic" abbreviation of the ERP and APD. To a much lesser extent, the same applied to propafenone, a predominantly Class 1C antidysrhythmic agent (1.65-3.3 x 10(-6) M/l). The 'ischaemia'-induced depression of Vmax was increased considerably by propafenone and diminished slightly by sotalol. The results are in keeping with the efficacy of propafenone and sotalol in ventricular arrhythmias of ischaemic origin and also with the proposal that the major mechanism by which propafenone inhibits postinfarction ventricular arrhythmias is a further depression of ischaemic myocardial cells resulting in conduction block of the reentrant wave front.