Abstract
Recent experimental studies suggested direct effects of the anti-influenza drug oseltamivir on cardiac electrophysiology. We therefore aimed at analyzing potential antiarrhythmic effects of oseltamivir on atrial fibrillation (AF) in an experimental whole-heart model. Twelve rabbit hearts were isolated and Langendorff perfused. Thereafter, hearts were paced at cycle lengths of 350, 250, and 200 ms in the atrium. A standardized protocol employing atrial burst pacing induced AF in 4 of 12 hearts under baseline conditions (33%, 11 episodes). Subsequently, a combination of acetylcholine (1 μM) and isoproterenol (1 μM) was administered to increase AF occurrence. Two monophasic action potential recordings on the left and two on the right atrial epicardium displayed a decrease of atrial action potential duration (aAPD, −38 ms, p < 0.01) and atrial effective refractory period (aERP; −20 ms, p < 0.05). Under the influence of acetylcholine/isoproterenol AF was inducible in 8 of 12 hearts (66%; 69 episodes). Additional infusion of oseltamivir (100 μM) resulted in a significant increase of both aAPD (+ 29 ms, p < 0.05) and aERP (+ 40 ms, p < 0.01) leading to an increase of atrial post-repolarization refractoriness (aPRR). Under the influence of oseltamivir only 3 of 12 hearts (25%, 8 episodes) remained inducible. In six additional hearts oseltamivir (50 μM and 100 μM) did not significantly alter ventricular APD, QRS duration and QT interval but induced a significant increase of ventricular ERP. In the present experimental study, acute infusion of the anti-influenza drug oseltamivir reduced atrial fibrillation. The antiarrhythmic effect can be explained by a significant increase in aERP and aPRR. These results suggest an antiarrhythmic potential of oseltamivir in atrial arrhythmias.
Similar content being viewed by others
References
Comtois P, Kneller J, Nattel S (2005) Of circles and spirals: bridging the gap between the leading circle and spiral wave concepts of cardiac reentry. Europace 7(Suppl 2):10–20
Franz MR, Burkhoff D, Spurgeon H, Weisfeldt ML, Lakatta EG (1986) In vitro validation of a new cardiac catheter technique for recording monophasic action potentials. Eur Heart J 7:34–41
Frommeyer G, Milberg P, Clauss C, Schmidt M, Ramtin S, Kaese S, Grundmann F, Grotthoff JS, Pott C, Eckardt L (2014) Electrophysiological profile of vernakalant in an experimental whole-heart model: the absence of proarrhythmia despite significant effect on myocardial repolarization. Europace 16:1240–1248
Frommeyer G, Milberg P, Schulze Grotthoff J, Dechering DG, Kochhauser S, Stypmann J, Fehr M, Breithardt G, Eckardt L (2015) Dronedarone and digitalis: individually reduced post-repolarization refractoriness enhances life-threatening arrhythmias. Europace 17:1300–1308
Frommeyer G, Rajamani S, Grundmann F, Stypmann J, Osada N, Breithardt G, Belardinelli L, Eckardt L, Milberg P (2012a) New insights into the beneficial electrophysiologic profile of ranolazine in heart failure: prevention of ventricular fibrillation with increased post-repolarization refractoriness and without drug-induced proarrhythmia. J Card Fail 18:939–949
Frommeyer G, Schmidt M, Clauss C, Kaese S, Stypmann J, Pott C, Eckardt L, Milberg P (2012b) Further insights into the underlying electrophysiological mechanisms for reduction of atrial fibrillation by ranolazine in an experimental model of chronic heart failure. Eur J Heart Fail 14:1322–1331
Frommeyer G, Sterneberg M, Dechering DG, Kaese S, Bogeholz N, Pott C, Fehr M, Bogossian H, Milberg P, Eckardt L (2017) Effective suppression of atrial fibrillation by the antihistaminic agent antazoline: first experimental insights into a novel antiarrhythmic agent. Cardiovasc Ther 35(2)
Fukushima A, Chazono K, Hashimoto Y, Iwajima Y, Yamamoto S, Maeda Y, Ohsawa M, Ono H (2015) Oseltamivir produces hypothermic and neuromuscular effects by inhibition of nicotinic acetylcholine receptor functions: comparison to procaine and bupropion. Eur J Pharmacol 762:275–282
Heijman J, Algalarrondo V, Voigt N, Melka J, Wehrens XH, Dobrev D, Nattel S (2016) The value of basic research insights into atrial fibrillation mechanisms as a guide to therapeutic innovation: a critical analysis. Cardiovasc Res 109:467–479
Hohnloser SH, Crijns HJ, van Eickels M, Gaudin C, Page RL, Torp-Pedersen C, Connolly SJ, Investigators A (2009) Effect of dronedarone on cardiovascular events in atrial fibrillation. New Engl J Med 360:668–678
Hohnloser SH, Halperin JL, Camm AJ, Gao P, Radzik D, Connolly SJ, investigators P (2014) Interaction between digoxin and dronedarone in the PALLAS trial. Circ Arrhythm Electrophsiol 7: 1019–1025
Jefferson T, Jones M, Doshi P, Spencer EA, Onakpoya I, Heneghan CJ (2014) Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. BMJ 348:g2545
Karplus R, Sanset S, Zaidenstein R, Schneider D, Berkovitch M (2010) Suspected oseltamivir-induced bradycardia. Int J Infect Dis 14(Suppl 3):e374–e375
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18:1609–1678
Kitahara K, Nakamura Y, Tsuneoka Y, Adachi-Akahane S, Tanaka H, Yamazaki H, Takahara A, Yamazaki J, Ikeda T, Sugiyama A (2013) Cardiohemodynamic and electrophysiological effects of anti-influenza drug oseltamivir in vivo and in vitro. Cardiovasc Toxicol 13:234–243
Kumar K, Nearing BD, Carvas M, Nascimento BC, Acar M, Belardinelli L, Verrier RL (2009) Ranolazine exerts potent effects on atrial electrical properties and abbreviates atrial fibrillation duration in the intact porcine heart. J Cardiovasc Electrophysiol 20:796–802
Maciag A, Farkowski MM, Chwyczko T, Beckowski M, Syska P, Kowalik I, Pytkowski M, Wozniak J, Dabrowski R, Szwed H (2016) Efficacy and safety of antazoline in the rapid cardioversion of paroxysmal atrial fibrillation (the AnPAF Study). Europace 19 in press
Milberg P, Frommeyer G, Ghezelbash S, Rajamani S, Osada N, Razvan R, Belardinelli L, Breithardt G, Eckardt L (2013) Sodium channel block by ranolazine in an experimental model of stretch-related atrial fibrillation: prolongation of interatrial conduction time and increase in post-repolarization refractoriness. Europace 15:761–769
Milberg P, Frommeyer G, Uphaus T, Kaiser D, Osada N, Breithardt G, Eckardt L (2012) Electrophysiologic profile of dronedarone on the ventricular level: beneficial effect on postrepolarization refractoriness in the presence of rapid phase 3 repolarization. J Cardiovasc Pharmacol 59:92–100
Nakamura Y, Sasaki R, Cao X, Wada T, Hamaguchi S, Izumi-Nakaseko H, Ando K, Tanaka H, Takahara A, Sugiyama A (2016) Intravenous anti-influenza drug oseltamivir will not induce torsade de pointes: evidences from proarrhythmia model and action-potential assay. J Pharmacol Sci 131:72–75
Sicouri S, Belardinelli L, Carlsson L, Antzelevitch C (2009) Potent antiarrhythmic effects of chronic amiodarone in canine pulmonary vein sleeve preparations. J Cardiovasc Electrophysiol 20:803–810
Takahara A, Suzuki S, Hagiwara M, Nozaki S, Sugiyama A (2013) Electrophysiological effects of an anti-influenza drug oseltamivir on the guinea-pig atrium: comparison with those of pilsicainide. Bio Pharm Bull 36:1650–1652
Wells Q, Hardin B, Raj SR, Darbar D (2010) Sotalol-induced torsades de pointes precipitated during treatment with oseltamivir for H1N1 influenza. Heart Rhythm 7:1454–1457
Acknowledgments
This study was supported by the German Cardiac Society (to G.F.) and the Dr. Peter Osypka Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Frommeyer, G., Mittelstedt, A., Wolfes, J. et al. The anti-influenza drug oseltamivir reduces atrial fibrillation in an experimental whole-heart model. Naunyn-Schmiedeberg's Arch Pharmacol 390, 1155–1161 (2017). https://doi.org/10.1007/s00210-017-1415-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00210-017-1415-y