Accentuated vagal antagonism paradoxically increases ryanodine receptor calcium leak in long-term exercised...

Long-term aerobic exercise alters autonomic balance, which may not be favorable in heart rate (HR)-dependent arrhythmic diseases including catecholaminergic polymorphic ventricular tachycardia (CPVT) because of preexisting bradycardia and increased sensitivity to parasympathetic stimulation.

The purpose of this study was to determine whether long-term exercise-induced autonomic adaptations modify CPVT susceptibility.

We determined exercise-induced parasympathetic effects on HR, arrhythmia incidence, and intracellular sarcoplasmic reticulum (SR) Ca²⁺ leak in atrial (ACM) and ventricular (VCM) cardiomyocytes, in exercised (EX) calsequestrin knockout (CASQ2^-/-) mice, a model of CPVT.

Although 8-week treadmill running improved exercise capacity in EX CPVT mice, the incidence and duration of ventricular tachycardia also increased. HR variability analyses revealed an increased high-frequency component of the power spectrum and root mean square of successive differences in R-R intervals indicating accentuated vagal antagonism during β-adrenergic stimulation resulting in negligible HR acceleration. In EX CASQ2^-/- VCM, peak amplitude of Ca²⁺ transient (CaT) increased, whereas SR Ca²⁺ content decreased. Aberrant Ca²⁺ sparks occurred at baseline, which was exacerbated with isoproterenol. Notably, although 10 microM of the cholinergic agonist carbachol prevented isoproterenol-induced Ca²⁺ waves in ACM, CaT amplitude, SR Ca²⁺ load, and isoproterenol-induced Ca²⁺ waves paradoxically increased in VCM. In parallel, ventricular ryanodine receptor (RyR2) protein expression increased, whereas protein kinase A- and calmodulin-dependent protein kinase II-mediated phosphorylation of RyR2 was not significantly altered, which could imply an increased number of "leaky" channels.

Our novel results suggest that long-term exercise in CASQ2^-/- mice increases susceptibility to ventricular arrhythmias by accentuating vagal antagonism during β-adrenergic challenge, which prevents HR acceleration and exacerbates abnormal RyR2 Ca²⁺ leak in EX CASQ2^-/- VCM.