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Sandor Györke, Brian M. Hagen, Dmitry Terentyev, W. Jonathan Lederer
Published in Volume 117, Issue 7
J Clin Invest. 2007; 117(7):1758–1762 doi:10.1172/JCI32496
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Figure 2
Ca2+-dependent arrhythmogenesis.

(A) Relationship between [Ca2+]SR and diastolic [Ca2+]i. As [Ca2+]i increases, so does [Ca2+]SR. (B) As [Ca2+]SR increases, so does SR Ca2+ leak. Any additional features that increase RyR2 openings (Po) will also increase Ca2+ leak. (C) As leak increases, there is an increasing loss of Ca2+ in the SR. (D) Probability of generating a cellular arrhythmia (i.e., a wave) (Pwave). [Ca2+]SR is the primary factor in Ca2+ overload arrhythmogenesis because it affects Po. However, as the leak increases, there is loss of Ca2+ from within the SR. Thus, increasing Po has a biphasic effect on Pwave. The relationship is biphasic because at low Po, [Ca2+]SR remains sufficiently high to produce substantial Ca2+ efflux and sustain the propagation of Ca2+ waves. When Po is very high, the Ca2+ leak outpaces SERCA2a; there is a net loss of [Ca2+]SR, and Pwave decreases. Increased SERCA2a activity (red curve) shifts the curve (48). The physiological range occurs at very low RyR2 Po (about 10–4 s–1).