Table 2.

Effect of flecainide on RyR2 mediated diastolic Ca2+ release in sparks and waves, including source of cells and brief description of experimental conditions and most significant results

Sparks, wavesPreparationMain effect of flecainide
Watanabe et al. (2009)  ISO-stimulated intact CSQ2−/− myocytes 6 µM reduced the rate of spontaneous Ca2+ release events in the presence and absence of extracellular Na+ and Ca2+ 
Hilliard et al. (2010)  (1) Field stimulated intact ventricular CSQ2−/− myocytes. Ca2+ waves triggered by 100 nM ISO
(2) Permeabilized rat ventricular myocytes without ISO 
6 µM reduced Ca2+ wave rates, spark amplitude and width. Spark mass reduced by 40%
Increase in spark frequency
No effect on spark-mediated SR Ca2+ leak or SR Ca2+ content 
Hwang et al. (2011)  (1) Field stimulated intact ventricular CSQ2−/− myocytes. Ca2+ waves with 100 nM ISO Flecainide and R-propafenone decreased rate of Ca2+ waves IC50 of 2.2 and 1.1 µM respectively. S-propafenone much less effective. SR Ca2+ content not altered by any of the three drugs 
Liu et al. (2011)  (1) Permeabilized mouse RyR2-R4496C+/− ventricular myocytes
(2) Intact ventricular myocytes with ISO 
Tetracaine, but not flecainide, (1) reduces spontaneous Ca2+ waves and sparks and (2) spontaneous Ca2+ release events and triggered beats, but no effect on DADs 
Savio-Galimberti and Knollman (2015)  Permeabilized CSQ2−/− ventricular myocytes Of all class I antiarrhythmic drugs, flecainide and R-propafenone inhibit Ca2+ waves with the highest potency and efficacy. Suggest reduced spark mass, not frequency, causes wave suppression. 
Sikkel et al. (2013)  Intact rat ventricular myocytes with patch clamp
Stimulation frequency adjusted to induce Ca2+ waves 
5 µM did not alter Ca2+ transients or SR Ca2+ load. Ca2+ wave and spark frequency and wave velocity declined
INa block (pharmacological or voltage-dependent inactivation) similarly reduced Ca2+ waves, spark frequency, and wave velocity. NCX implicated with INa change 
Savio-Galimberti and Knollman (2015)  Saponin-permeabilized ventricular myocytes from CSQ2−/−, RyR2-R4496C+/−, C57BL/6 WT mice and WT rabbits RyR2 activity determines the potency of open-state blockers flecainide and R-propafenone, but not tetracaine, for suppressing arrhythmogenic Ca2+ waves 
Bannister et al. (2016)  Intact rat ventricular myocytes, drugs infused into cells through patch electrodes Spark frequency declined with flecainide and QX-FL, but not with NU-FL
No change in spark amplitude or mass with any of the compounds 
Hwang et al. (2019)  CSQ2−/− and RyR2-R4496C+/− intact ventricular myocytes Spontaneous Ca2+ release blocked, IC50 ∼2 µM. Similar efficacy in both models despite different phenotype severity 
Kryshtal et al. (2021)  CSQ2−/− ventricular myocytes Flecainide, but not QX-FL and NU-FL, reduced Ca2+ wave frequency in both permeabilized myocytes (lacking surface membrane and Na+ channels) and in voltage clamped TTX-treated myocytes 
Sparks, wavesPreparationMain effect of flecainide
Watanabe et al. (2009)  ISO-stimulated intact CSQ2−/− myocytes 6 µM reduced the rate of spontaneous Ca2+ release events in the presence and absence of extracellular Na+ and Ca2+ 
Hilliard et al. (2010)  (1) Field stimulated intact ventricular CSQ2−/− myocytes. Ca2+ waves triggered by 100 nM ISO
(2) Permeabilized rat ventricular myocytes without ISO 
6 µM reduced Ca2+ wave rates, spark amplitude and width. Spark mass reduced by 40%
Increase in spark frequency
No effect on spark-mediated SR Ca2+ leak or SR Ca2+ content 
Hwang et al. (2011)  (1) Field stimulated intact ventricular CSQ2−/− myocytes. Ca2+ waves with 100 nM ISO Flecainide and R-propafenone decreased rate of Ca2+ waves IC50 of 2.2 and 1.1 µM respectively. S-propafenone much less effective. SR Ca2+ content not altered by any of the three drugs 
Liu et al. (2011)  (1) Permeabilized mouse RyR2-R4496C+/− ventricular myocytes
(2) Intact ventricular myocytes with ISO 
Tetracaine, but not flecainide, (1) reduces spontaneous Ca2+ waves and sparks and (2) spontaneous Ca2+ release events and triggered beats, but no effect on DADs 
Savio-Galimberti and Knollman (2015)  Permeabilized CSQ2−/− ventricular myocytes Of all class I antiarrhythmic drugs, flecainide and R-propafenone inhibit Ca2+ waves with the highest potency and efficacy. Suggest reduced spark mass, not frequency, causes wave suppression. 
Sikkel et al. (2013)  Intact rat ventricular myocytes with patch clamp
Stimulation frequency adjusted to induce Ca2+ waves 
5 µM did not alter Ca2+ transients or SR Ca2+ load. Ca2+ wave and spark frequency and wave velocity declined
INa block (pharmacological or voltage-dependent inactivation) similarly reduced Ca2+ waves, spark frequency, and wave velocity. NCX implicated with INa change 
Savio-Galimberti and Knollman (2015)  Saponin-permeabilized ventricular myocytes from CSQ2−/−, RyR2-R4496C+/−, C57BL/6 WT mice and WT rabbits RyR2 activity determines the potency of open-state blockers flecainide and R-propafenone, but not tetracaine, for suppressing arrhythmogenic Ca2+ waves 
Bannister et al. (2016)  Intact rat ventricular myocytes, drugs infused into cells through patch electrodes Spark frequency declined with flecainide and QX-FL, but not with NU-FL
No change in spark amplitude or mass with any of the compounds 
Hwang et al. (2019)  CSQ2−/− and RyR2-R4496C+/− intact ventricular myocytes Spontaneous Ca2+ release blocked, IC50 ∼2 µM. Similar efficacy in both models despite different phenotype severity 
Kryshtal et al. (2021)  CSQ2−/− ventricular myocytes Flecainide, but not QX-FL and NU-FL, reduced Ca2+ wave frequency in both permeabilized myocytes (lacking surface membrane and Na+ channels) and in voltage clamped TTX-treated myocytes 

Publications are listed in chronological order. ISO, isoproterenol.

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