Regional differences in current density and rate-dependent properties of the transient outward current in subepicardial and subendocardial myocytes of human left ventricle

Background Recordings of outward currents in human ventricular myocytes revealed the presence of a large calcium-insensitive transient outward current. This current has been suggested to contribute significantly to regional electrophysiological heterogeneity in myocardial cells and tissue of several animal species and to cause electrical gradients across the ventricular wall. Methods and Results The patch-clamp technique was used to record action potentials and outward currents in myocytes enzymatically isolated from thin subepicardial and subendocardial layers of human nonfailing and failing left ventricle. In all subepicardial cells studied, a calcium-insensitive transient outward current (I-to 1) could be recorded with large density (10.6 +/- 1.08 pA/pF at 40 mV), whereas current density of I-to 1, in subendocardial cells was fourfold smaller (2.63 +/- 0.31 pA/pF, P < .0001, nonfailing myocardium). In failing hearts, the density of I-to 1 was significantly smaller in subepicardial cells (7.81 +/- 0.53 pA/pF, P = .012) but not different in subendocardial myocytes (2.01 +/- 0.23 pA/pF, P = .25). Rate-dependent reduction of peak I-to 1 at a 2-Hz depolarization rate was minimal in subepicardial cells (to 92.3 +/- 1.9%), whereas peak I-to 1 in subendocardial myocytes was almost suppressed at 2 Hz (reduction to 13.2 +/- 2.1%. P < .0001). The different rate-dependent reduction of the transient outward current was due to a much slower time course of recovery from inactivation in subendocardial cells. Kinetic data, including action potentials recorded at 35 degrees C, allow assessment of the role of the transient outward current for electrical activity and transmural voltage gradients in human left ventricle. Conclusions Marked regional differences in density and rate-dependent properties of the transient outward current exist in subendocardial and subepicardial layers in human left ventricular myocardium, causing transmural electrical gradients that are important for normal and pathological electrical behavior of the human heart. The difference in recovery rates of the transient outward current is a distinguishing feature between subepicardial and subendocardial myocytes.