Sudden cardiac death occurs due to aberrations in the multifactorial process that is cardiac conduction. Conduction velocity (CV) and its modulation by several determinants, like cellular excitability, tissue structure and electrical coupling by gap junctions (GJ), have been extensively studied. However, there are several discrepancies in cardiac electrophysiology research that have extended over decades, suggesting elements that are still not completely understood about this complex phenomenon. This dissertation will focus on one such mechanism, ephaptic coupling (EpC). The purpose of this work is twofold, 1) to identify ionic determinants of EpC, and its interactions with gap junctional coupling (GJC) and, 2) to investigate the possible role of serum ion modulation in cardiac arrhythmia therapy.

First, the effects of altering extracellular ion concentration – sodium, potassium and calcium at varying GJ protein expression were studied. Briefly, reducing sodium was related to CV slowing under conditions of reduced EpC (wide intercalated disc nanodomains – perinexi) and GJC (reduced GJ protein – Connexin43). On the other hand, increasing potassium slowed CV in hearts with wide perinexi independent of GJC. Elevating calcium, reduced perinexal width and was associated with fast CV during physiologic sodium concentration. However, under conditions associated with disease, like hyponatremia, elevating calcium still reduced perinexal width but slowed CV. These findings are the first to suggest that ionic modulators of EpC could modulate CV during health and disease.

Next, the potential of perfusate ion modulation in cardiac arrhythmia therapy was investigated. Briefly, in a model of myocardial inflammation, TNFα, a pro-inflammatory cytokine, slowed CV relative to control conditions and this was associated with widening of the perinexus (reduced EpC). Increasing extracellular calcium restored CV to control values by improving not only EpC but also GJC. Finally, in a model of metabolic ischemia in the heart, CV response due to solutions with varying sodium and calcium concentrations were tested. The solutions that were associated with wider perinexi and elevated sodium performed best during ischemia by attenuating CV slowing, reducing arrhythmias and increasing time to asystole. Taken together, these findings provide evidence for the possibility of ionic determinants of EpC in cardiac arrhythmia therapy.