Cardiotoxic effects of fenfluramine hydrochloride on isolated cardiac preparations and ventricular myocytes of guinea-pigs

1 The cardiotoxic effects of fenfluramine hydrochloride on mechanical and electrical activity were studied in papillary muscles, Purkinje fibres, left atria and ventricular myocytes of guinea-pigs. 2 Force of contraction (f(c)) was measured isometrically, action potentials and maximum rate of rise of the action potential (V-max) were recorded by means of the intracellular microelectrode technique and the sodium current (I-Na) with patch-clamp technique in the cell-attached mode. For kinetic analysis (S)-DPI-201-106-modified Na+ channels from isolated guinea-pig ventricular heart cells were used. 3 Fenfluramine (1-300 mu M) produced negative chronotropic and inotropic effects; additional extracellular Ca2+ competitively antagonized the negative inotropic effect. 4 Fenfluramine concentration-dependently reduced V-max and showed tonic blockade of sodium channels, shortened the action potential duration in papillary muscles and Purkinje fibres. 5 In cell-attached patches, fenfluramine decreased I-Na concentration-dependently (10-100 mu M), frequency-independently (0.1-3 Hz; 30 mu M). The h(infinity) curve was shifted towards hyperpolarizing direction. At 30 mu M, fenfluramine blocked the sodium channel at all test potentials to the same degree, and neither changed the threshold and reversal potentials nor the peak of the curve. 6 No effect on single channel availability, but a significant decrease in mean open times and increase in mean closed times was observed. 7 Mean duration of the bursts decreased and number of openings per record increased with increasing drug concentration. 8 It is concluded that the effect on I-Na plays an important role in the cardiotoxicity of fenfluramine in addition to primary pulmonary hypertension and valvular disorders.