Sex- and age-dependent susceptibility to ventricular arrhythmias in the rat heart ex vivo.

Background The incidence of life-threatening ventricular arrhythmias, the most common cause of sudden cardiac death (SCD), depends largely on the arrhythmic substrate that develops in the myocardium during the aging process. There is a huge deficit of comparative studies on the development of this substrate in both sexes, with a particular paucity of studies in females. Methods To identify the substrate of arrhythmia, fibrosis, cardiomyocyte hypertrophy, mitochondrial density, level of oxidative stress, antioxidant defense and intracellular Ca 2+ signaling in isolated cardiomyocytes were measured in the hearts of 3- and 24-month-old female and male rats. Arrhythmia susceptibility was assessed in ex vivo perfused hearts after exposure to isoproterenol (ISO) and hydrogen peroxide (H 2 O 2 ). The number of ventricular premature beats (PVBs), ventricular tachycardia (VT) and ventricular fibrillation (VF) episodes, as well as intrinsic heart rate, QRS and QT duration, were measured in ECG signals recorded from the surfaces of the beating hearts. Results After ISO administration, VT/VFs were formed only in the hearts of males, mainly older ones. In contrast, H 2 O 2 led to VT/VF formation in the hearts of rats of both sexes but much more frequently in older males. We identified several components of the arrhythmia substrate that develop in the myocardium during the aging process, including high spontaneous ryanodine receptor activity in cardiomyocytes, fibrosis of varying severity in different layers of the myocardium (nonheterogenic fibrosis), and high levels of oxidative stress as measured by nitrated tyrosine levels. All of these elements appeared at a much higher intensity in male individuals during the aging process. On the other hand, in aging females, antioxidant defense at the level of H 2 O 2 detoxification measured as glutathione peroxidase expression was weaker than in males of the same age. Conclusion We have shown that sex has a significant effect on the development of an arrhythmic substrate in aging. This substrate determines the incidence of life-threatening ventricular arrhythmias in the presence of additional stimuli with proarrhythmic potential, such as catecholamine stimulation or oxidative stress, which are constant elements in the pathomechanism of most cardiovascular diseases.