Adenosine-induced atrial fibrillation

Ning Li, Thomas A. Csepe, Brian J. Hansen, Lidiya V. Sul, Anuradha Kalyanasundaram, Stanislav O. Zakharkin, Jichao Zhao, Avirup Guha, David R. Van Wagoner, Ahmet Kilic, Peter J. Mohler, Paul M.L. Janssen, Brandon J. Biesiadecki, John D. Hummel, Raul Weiss, Vadim V. Fedorov

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Background: Adenosine provokes atrial fibrillation (AF) with a higher activation frequency in right atria (RA) versus left atria (LA) in patients, but the underlying molecular and functional substrates are unclear. We tested the hypothesis that adenosine-induced AF is driven by localized reentry in RA areas with highest expression of adenosine A1 receptor and its downstream GIRK (G protein-coupled inwardly rectifying potassium channels) channels (I K,Ado). Methods: We applied biatrial optical mapping and immunoblot mapping of various atrial regions to reveal the mechanism of adenosine-induced AF in explanted failing and nonfailing human hearts (n=37). Results: Optical mapping of coronary-perfused atria (n=24) revealed that adenosine perfusion (10-100 mol/L) produced more significant shortening of action potential durations in RA (from 290±45 to 239±41 ms, 17.3±10.4%; P<0.01) than LA (from 307±24 to 286±23 ms, 6.7±6.6%; P<0.01). In 10 hearts, adenosine induced AF (317±116 s) that, when sustained (≥2 minutes), was primarily maintained by 1 to 2 localized reentrant drivers in lateral RA. Tertiapin (10-100 nmol/L), a selective GIRK channel blocker, counteracted adenosine-induced action potential duration shortening and prevented AF induction. Immunoblotting showed that the superior/middle lateral RA had significantly higher adenosine A1 receptor (2.7±1.7-fold; P<0.01) and GIRK4 (1.7±0.8-fold; P<0.05) protein expression than lateral/posterior LA. Conclusions: This study revealed a 3-fold RA-to-LA adenosine A1 receptor protein expression gradient in the human heart, leading to significantly greater RA versus LA repolarization sensitivity in response to adenosine. Sustained adenosine-induced AF is maintained by reentrant drivers localized in lateral RA regions with the highest adenosine A1 receptor/GIRK4 expression. Selective atrial GIRK channel blockade may effectively treat AF during conditions with increased endogenous adenosine.

Original languageEnglish (US)
Pages (from-to)486-498
Number of pages13
Issue number6
StatePublished - Aug 9 2016
Externally publishedYes


  • G protein-coupled inwardly rectifying potassium channels
  • adenosine
  • atrial fibrillation
  • optical mapping
  • receptor, adenosine A1
  • tertiapin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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