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The heart is a complex organ governed by both cardiac-intrinsic and extrinsic influences such as those that originate in the brain. The sinoatrial node (SAN) is a defined region in the heart that houses the pacemaker cells (also referred to as sinoatrial cells, or SA cells) responsible for the initiation and perpetuation of the mammalian heartbeat1,2. The intrinsic heart rate is the rate driven by the pacemaker cells without influence by other cardiac or neuro-humoral influences, but traditional measures of heart rate in humans and live animals, such as electrocardiograms, reflect both the pacemaker and neural influences on the heart. The most notable neural influence on SA cells is from the autonomic nervous system, which constantly modulates firing patterns to meet the physiological requirements of the body3. Supporting this idea, both sympathetic and parasympathetic projections can be found near the SAN4. The intrinsic cardiac nervous system (ICNS) is another important neural influence where ganglionated plexi, specifically in the right atria, innervate and regulate the activity of the SAN5,6.
Understanding pacemaking deficits is clinically important, as dysfunction can underlie many cardiac disorders, as well as contribute to the risk of other complications. Sick sinus syndrome (SSS) is a category of diseases characterized by dysfunction of the sinoatrial node which impedes proper pacemaking7,8. SSS can present with sinus bradycardia, sinus pauses, sinus arrest, sinoatrial exit block, and alternating bradyarrythmias and tachyarrhythmias9 and can lead to complications including increased risk of embolic stroke and sudden death8,10. Those with Brugada syndrome, a cardiac disorder marked by ventricular fibrillation with an increased risk of sudden cardiac death, are at greater risk for arrhythmogenic events if they also have comorbid SAN dysfunction11,12. Sinoatrial dysfunction may also have physiological consequences beyond the heart. For example, SSS has been observed to trigger seizures in a patient due to cerebral hypoperfusion13.
To identify sinoatrial pacemaking deficits, intrinsic heart rates need to be determined by measuring the activity of the SAN without the influence of the autonomic nervous system or humoral factors. Clinically, this can be approximated by pharmacological autonomic blockade14, but this same technique can also be applied in mammalian models to study intrinsic cardiac function15,16. While this approach blocks a large portion of contributing neural influences and allows for in vivo cardiac examination, it does not completely eliminate all extrinsic influences on the heart. Another research technique used to study intrinsic cardiac function in animal models is isolated heart recordings using Langendorff-perfused hearts, which typically involve measurements using electrograms, pacing, or epicardial multielectrode arrays17,18,19,20. While this technique is more specific to cardiac function since it involves removing the heart from the body, the measurements may still be influenced by mechano-electric autoregulatory mechanisms that could influence intrinsic heart rate measurements21. The isolated heart recordings may also still be influenced by autonomic regulation through the ICNS5,6,22,23. Furthermore, maintaining a physiologically relevant temperature of the heart, which is critical for cardiac function measurements, can be difficult in isolated heart approaches20. A more direct method to study SAN function is to specifically isolate SAN tissue and measure its activity. This can be accomplished through SAN strips (isolated SAN tissue) or isolated SAN pacemaker cells24,25. Both require a high degree of technical training, as the SAN is a very small and highly defined region, and cell isolation poses an even greater challenge as dissociation can damage the overall health of the cell if not performed correctly. Furthermore, these techniques require expert electrophysiological skills in order to successfully record from the tissue or cells using individual recording microelectrodes.
In this protocol, we describe a technique to record the SAN in vitro by using a microelectrode array (MEA) to obtain intrinsic heart rate measurements. This approach has the advantage of making highly specific electrophysiological recordings accessible to researchers lacking intensive electrophysiological skillsets. MEAs have previously been used to study cardiomyocyte function in primary cardiomyocyte cultures26,27,28,29,30,31,32, cardiac sheets33,34,35,36,37,38,39, and tissue whole mounts40,41,42,43,44,45,46,47. Previous work has also been done to examine field potentials in SAN tissue41,42. Here, we provide a methodology to use the MEA to record and analyze murine intrinsic SAN firing rates. We also describe how this technique can be used to test pharmacological effects of drugs on SAN intrinsic firing rates by providing a sample experiment showing the effects of 4-aminopyridine (4-AP), a voltage-gated K+ channel blocker. Using defined anatomical landmarks, we can accurately record the SAN without having to perform the extensive tissue dissections or cell isolations required in other methods. While the MEA can be cost-prohibitive, the recordings provide highly specific and reliable measures of pacemaking that can be used in a vast array of clinical and physiological research applications.