The hyperpolarization-activated inward current (If) has been discussed to contribute to arrhythmias in human atrial myocardium. If was found to be increased by beta-adrenergic stimulation. In the present study, we evaluate the modulation of If by carbachol, adenosine and by class Ic, III and IV antiarrhythmic drugs in isolated human atrial myocytes. The whole-cell patch-clamp technique was used to record If in isolated myocytes from 18 human right atrial appendages. A typical time- and voltage-dependent hyperpolarization-activated inward current could be recorded in all cells investigated (n=56). Mean current density recorded at -130 mV was -2.8+/-1.2 pApF(-1). Both adenosine and carbachol were found to directly inhibit If in human atrial myocytes by shifting the activation curves to more negative potentials. Adenosine 10(-5) mol/l shifted the potential of half-maximal activation by -5.9+/-0.4 mV from -99.4+/-0.6 mV to -105.3+/-0.4 mV (n=8; P<0.05), and carbachol 10(-5) mol/l by -5.7+/-0.5 mV from -99.2+/-0.5 mV to -104.9+/-0.6 mV (n=6; P<0.05). The concentration-response curve of adenosine calculated by a Hill function yielded a half-maximal effect of adenosine (EC50) at a concentration of 3.6+/-0.5 micromol/l, a maximal shift of -6.5+/-0.3 mV, and a Hill coefficient (h) of 2.40. We did not observe any effect of flecainide (10(-5) mol/l; n=8), sotalol (10(-5) mol/l; n=6), amiodarone (10(-5) mol/l; n=6) or verapamil (10(-5) mol/l; n=5) on If in human atrial myocytes. However, propafenone (10(-5) mol/l) was found to reversibly reduce If current size (9/13 cells) by shifting the activation curve by -5.2+/-0.4 mV (P<0.05). In human atria adenosine- and muscarinic receptor stimulation might function as endogenous protective mechanisms inhibiting the initiation of ectopic tachycardia by reducing If current size. Propafenone may be more effective in some patients with atrial tachycardias that do not respond to other class Ic, III and IV antiarrhythmic drugs. However, it has yet to be defined whether these agents suppress atrial tachycardias via an inhibition of If in vivo.