Altered K⁺ current profiles underlie cardiac action potential shortening in hyperkalemia and β-adrenergic stimulation

Hyperkalemia is known to develop in various conditions including vigorous physical exercise. In the heart, hyperkalemia is associated with action potential (AP) shortening that was attributed to altered gating of K + channels. However, it remains unknown how hyperkalemia changes the profiles of each K + current under a cardiac AP. Therefore, we recorded the major K + currents (inward rectifier K + current, I K1 ; rapid and slow delayed rectifier K + currents, I Kr and I Ks , respectively) using AP-clamp in rabbit ventricular myocytes. As K + may accumulate at rapid heart rates during sympathetic stimulation, we also examined the effect of isoproterenol on these K + currents. We found that I K1 was significantly increased in hyperkalemia, whereas the reduction of driving force for K + efflux dominated over the altered channel gating in case of I Kr and I Ks . Overall, the markedly increased I K1 in hyperkalemia overcame the relative decreases of I Kr and I Ks during AP, resulting in an increased net repolarizing current during AP phase 3. β-Adrenergic stimulation of I Ks also provided further repolarizing power during sympathetic activation, although hyperkalemia limited I Ks upregulation. These results indicate that facilitation of I K1 in hyperkalemia and β-adrenergic stimulation of I Ks represent important compensatory mechanisms against AP prolongation and arrhythmia susceptibility.