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The opinions expressed in this article are not necessarily those of the editors
or of the American Heart Association.
From the Cardiovascular Diseases, Mayo Clinic, Rochester, MN (A.A.C., V.K.S.);
Mayo Graduate School, Rochester, MN (A.A.C.); Specialty Registrar, Cardiology
and Internal Medicine, London Deanery, University College London Partners,
London, UK (A.A.C.).
Correspondence to: Virend K. Somers, MBChB, DPhil (Oxon), Department of
Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905.
E-mail: somers.virend@mayo.edu
J Am Heart Assoc. 2016;5:e004195 doi: 10.1161/JAHA.116.004195.
2016 The Authors. Published on behalf of the American Heart Association,
Inc., by Wiley Blackwell. This is an open access article under the terms of the
Creative Commons Attribution-NonCommercial License, which permits use,
distribution and reproduction in any medium, provided the original work is
properly cited and is not used for commercial purposes.
DOI: 10.1161/JAHA.116.004195
Figure 1. Schematic representation of types of action potential (AP) throughout the heart. The major differences are between the nodal tissues
(sinoatrial and atrioventricular nodes) and ventricular Purkinje/myocardium. (A) on the left hand side, the ventricular AP and associated Na+, K+,
and Ca2+ channels are shown. Phase 0 corresponds with the QRS wave, phase 3 with the peak of the T wave, phase 4 with the isoelectric line of
the surface ECG changes. (B) action potentials from different regions within the heart. ICa indicates inward calcium current L-type; IKr, delayed
inward rectier K+; IKs, slowly activating K+ channel; INa, inward voltage-dependent sodium channel; INCX, sodium-calcium exchanger; Ito, transient
outward; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. Adapted from Dumotier, Heart12 by permission from BMJ Publishing
Group Limited, and from Nattel et al, Physiological Reviews,13 with permission by the American Physiological Society.
Summary
This study is the rst to link potential mechanisms between
OSA and prolonged QTc and SCD, suggesting an inverse
association with mRNA expression of K+ channels with
severity of OSA. CPAP therapy diminishing OSA is able to
Journal of the American Heart Association
EDITORIAL
Figure 2. Schematic outlining potential pathophysiological aspects of OSA, disease mechanisms, and
development of associated CVD. Ion channel remodeling may be an important mechanism in associated
CVD increasing the propensity for SCD directly and indirectly. Modied from Somers et al, Circulation,10
with permission from Wolters Kluwer. CVD indicates cardiovascular diseases; OSA, obstructive sleep apnea;
SCD, sudden cardiac death; VF, ventricular brillation; VT, ventricular tachycardia.
Sources of Funding
This publication was made possible by Translational Science
Award Grant Number UL1 TR000135, supporting the Mayo
Clinic Center for Clinical and Translational Science (CCaTS),
Journal of the American Heart Association
Disclosures
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EDITORIAL
Ion Channel RemodelingA Potential Mechanism Linking Sleep Apnea and Sudden Cardiac
Death
Anwar Ahmed Chahal and Virend K. Somers
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