Targeting late ICaL to close the window to ventricular arrhythmias

Abstract

Triggered arrhythmias originate from aberrant cell membrane depolarizations that occur during or after completion of the cardiac action potential (AP). Although the phenomenon was recognized early and associated with cardiac arrhythmias in recordings relying on monophasic APs (Segers, 1941; Bozler, 1943), the concept of triggered activity was coined several decades later by Paul Cranefield (Cranefield, 1975) who, incidentally, served as editor-in-chief of this journal for more than 25 yr. This new term aimed to differentiate the slow membrane depolarization that depends on a previous AP (triggered activity) from automaticity, a slow membrane depolarization with different properties like the rhythmicity and spontaneity and independence on a preceding AP. Cranefield also originated the term “afterdepolarizations” for this triggered activity and described what are now traditionally known as early afterdepolarizations (EADs) “…that appears before the membrane potential has returned to the level it had at the beginning of the upstroke of the action potential,” and delayed afterdepolarizations (DADs), which occur “…after repolarization is complete i.e., after the membrane potential has returned to the level seen before the action potential” (Cranefield, 1975, 1977).