The Small Conductance Calcium-Activated Potassium Channel Inhibitors NS8593 and UCL1684 Prevent the Development of Atrial Fibrillation Through Atrial-Selective Inhibition of Sodium Channel Activity

J Cardiovasc Pharmacol. 2020 Aug;76(2):164-172. doi: 10.1097/FJC.0000000000000855.


The mechanisms underlying atrial-selective prolongation of effective refractory period (ERP) and suppression of atrial fibrillation (AF) by NS8593 and UCL1684, small conductance calcium-activated potassium (SK) channel blockers, are poorly defined. The purpose of the study was to confirm the effectiveness of these agents to suppress AF and to probe the underlying mechanisms. Transmembrane action potentials and pseudoelectrocardiograms were recorded from canine isolated coronary-perfused canine atrial and ventricular wedge preparations. Patch clamp techniques were used to record sodium channel current (INa) in atrial and ventricular myocytes and human embryonic kidney cells. In both atria and ventricles, NS8593 (3-10 µM) and UCL1684 (0.5 µM) did not significantly alter action potential duration, suggesting little to no SK channel inhibition. Both agents caused atrial-selective: (1) prolongation of ERP secondary to development of postrepolarization refractoriness, (2) reduction of Vmax, and (3) increase of diastolic threshold of excitation (all are sodium-mediated parameters). NS8593 and UCL1684 significantly reduced INa density in human embryonic kidney cells as well as in atrial but not in ventricular myocytes at physiologically relevant holding potentials. NS8593 caused a shift of steady-state inactivation to negative potentials in atrial but not ventricular cells. NS8593 and UCL1684 prevented induction of acetylcholine-mediated AF in 6/6 and 8/8 preparations, respectively. This anti-AF effect was associated with strong rate-dependent depression of excitability. The SK channel blockers, NS8593 and UCL1684, are effective in preventing the development of AF due to potent atrial-selective inhibition of INa, causing atrial-selective prolongation of ERP secondary to induction of postrepolarization refractoriness.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 1-Naphthylamine / analogs & derivatives*
  • 1-Naphthylamine / pharmacology
  • Action Potentials / drug effects
  • Alkanes / pharmacology*
  • Animals
  • Anti-Arrhythmia Agents / pharmacology*
  • Atrial Fibrillation / metabolism
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / prevention & control*
  • Dogs
  • Female
  • HEK293 Cells
  • Heart Atria / drug effects*
  • Heart Atria / metabolism
  • Heart Atria / physiopathology
  • Heart Rate / drug effects*
  • Heart Ventricles / drug effects
  • Heart Ventricles / metabolism
  • Heart Ventricles / physiopathology
  • Humans
  • Male
  • Myocytes, Cardiac / drug effects*
  • Myocytes, Cardiac / metabolism
  • NAV1.5 Voltage-Gated Sodium Channel / drug effects*
  • NAV1.5 Voltage-Gated Sodium Channel / genetics
  • NAV1.5 Voltage-Gated Sodium Channel / metabolism
  • Potassium Channel Blockers / pharmacology
  • Quinolinium Compounds / pharmacology*
  • Refractory Period, Electrophysiological / drug effects
  • Small-Conductance Calcium-Activated Potassium Channels / antagonists & inhibitors
  • Small-Conductance Calcium-Activated Potassium Channels / metabolism
  • Sodium Channel Blockers / pharmacology*


  • (R)-N-(benzimidazol-2-yl)-1,2,3,4-tetrahydro-1-naphthylamine
  • 6,10-diaza-3(1,3),8(1,4)dibenzena-1,5(1,4)diquinolinacyclodecaphane
  • Alkanes
  • Anti-Arrhythmia Agents
  • NAV1.5 Voltage-Gated Sodium Channel
  • Potassium Channel Blockers
  • Quinolinium Compounds
  • SCN5A protein, human
  • Small-Conductance Calcium-Activated Potassium Channels
  • Sodium Channel Blockers
  • 1-Naphthylamine