Endogenous subthreshold noise and PIP ₂ tune diastolic coherence across the intact sinoatrial node through stochastic...

The heartbeat originates in the sinoatrial (SA) node, where spontaneously firing pacemaker myocytes interact to generate a coherent rhythm. The classical entrainment account is deterministic: the fastest cells entrain the rest, and variability is an error term that coupling suppresses. We proposed previously that the node instead exploits its own noise through stochastic resonance, with rhythm quality peaking at intermediate fluctuation amplitude, and since mapped a metabolic gradient capable of supplying it. Two-photon imaging of the voltage sensor ASAP5 in the intact mouse node resolved the subthreshold regime that tissue-scale mapping averages away. Diastolic coherence followed an inverted-U against endogenous noise amplitude in both poles, with optima 3.5-fold apart, and each pole operated near its own. β-adrenergic stimulation raised noise in both poles to a common level. The inferior pole, which began below its optimum, gained coherence, while the superior pole, already at its optimum, lost interval regularity. Blocking HCN-mediated I _f with ivabradine lowered superior coherence without changing superior noise, and lowered inferior noise without lowering inferior coherence, dissociating the two coordinates. Thus, coherence is a surface defined by noise and coupled-clock drive. Phosphoinositide 4,5-bisphosphate (PIP ₂ ), an ATP-dependent lipid cofactor for HCN channels, increased firing rate and noise in both poles but improved coherence only in the energy-poor inferior node. Prior I _f block abolished that rescue. Pacemaking is therefore graded by a bioenergetic supply chain that sets the noise, not by entrainment alone. Noise, long treated as a nuisance to be averaged away, is an active ingredient of the pacemaker.