A circadian clock in the sinus node mediates day-night rhythms in Hcn4 and heart rate

Heart Rhythm. 2021 May;18(5):801-810. doi: 10.1016/j.hrthm.2020.11.026. Epub 2020 Dec 3.


Background: Heart rate follows a diurnal variation, and slow heart rhythms occur primarily at night.

Objective: The lower heart rate during sleep is assumed to be neural in origin, but here we tested whether a day-night difference in intrinsic pacemaking is involved.

Methods: In vivo and in vitro electrocardiographic recordings, vagotomy, transgenics, quantitative polymerase chain reaction, Western blotting, immunohistochemistry, patch clamp, reporter bioluminescence recordings, and chromatin immunoprecipitation were used.

Results: The day-night difference in the average heart rate of mice was independent of fluctuations in average locomotor activity and persisted under pharmacological, surgical, and transgenic interruption of autonomic input to the heart. Spontaneous beating rate of isolated (ie, denervated) sinus node (SN) preparations exhibited a day-night rhythm concomitant with rhythmic messenger RNA expression of ion channels including hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4). In vitro studies demonstrated 24-hour rhythms in the human HCN4 promoter and the corresponding funny current. The day-night heart rate difference in mice was abolished by HCN block, both in vivo and in the isolated SN. Rhythmic expression of canonical circadian clock transcription factors, for example, Brain and muscle ARNT-Like 1 (BMAL1) and Cryptochrome (CRY) was identified in the SN and disruption of the local clock (by cardiomyocyte-specific knockout of Bmal1) abolished the day-night difference in Hcn4 and intrinsic heart rate. Chromatin immunoprecipitation revealed specific BMAL1 binding sites on Hcn4, linking the local clock with intrinsic rate control.

Conclusion: The circadian variation in heart rate involves SN local clock-dependent Hcn4 rhythmicity. Data reveal a novel regulator of heart rate and mechanistic insight into bradycardia during sleep.

Keywords: Bradycardia; Circadian rhythm; Pacemaking; Sinus node; Vagus nerve.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bradycardia / genetics*
  • Bradycardia / metabolism
  • Bradycardia / physiopathology
  • Circadian Clocks / physiology*
  • Disease Models, Animal
  • Electrocardiography / methods*
  • Gene Expression Regulation*
  • Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels / biosynthesis
  • Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels / genetics*
  • Mice
  • RNA / genetics*
  • Sinoatrial Node / physiopathology*


  • Hcn4 protein, mouse
  • Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels
  • RNA