Electromechanical effects of protamine in isolated human atrial and canine ventricular tissues

Effects of protamine sulfate (1-100 mg%) on the electrical and mechanical activities of isolated dog ventricular tissues and human atrial fibers were studied. In dog Purkinje fibers, 10 mg% protamine reduced markedly the maximum diastolic potential and the rate of phase 0 depolarization. Eventually, slow response action potential developed at a depolarized level and the twitch force declined abruptly. The depolarization and the negative inotropy were reversed by increasing [Ca])o or [K]o but not by tetrodotoxin. When Purkinje fibers were depolarized in 27 mM [K]o Tyrode solution plus 0.5 microM epinephrine, higher concentrations of protamine (30 mg% or above) were required to depress the slow response action potentials and twitch, in contrast to the action of verapamil and diltiazem (1-30 microM). Dog ventricular and human atrial muscle fibers were more resistant to the depressant effects of protamine. In human atrial fibers, however, 10 mg% protamine was able to depress significantly the oscillatory afterpotentials and aftercontractions induced by epinephrine and theophylline. The present findings suggest that the depolarization and decline in force of cardiac tissues induced by protamine, at a concentration about twice of the maximum clinically relevant dose, may be explained by the development of slow response action potentials as a result of decrease in membrane K+ and Na+ conductances.