Biophysical defects in voltage-gated sodium channels associated with Long QT and Brugada syndromes

The activity of voltage-gated sodium channels contributes to onset and duration of the cardiac action potential through an intricate balance with the activity of other ion channels. Activation of sodium channels leads to membrane depolarization and Phase 0 of the cardiac action potential. Sodium channel fast inactivation contributes to Phase 1, the initial repolarization. Slow inactivation and closed state fast inactivation determine channel availability and, thus, overall membrane excitability. Defects in any of these biophysical states or transitions between them, imparted by (over 170 reported thus far, including both Long QT3 and Brugada syndromes) mutations in the (over 2000) amino acids that compose the sodium channel protein, can lead to channel dysfunction that manifests as an abnormal cardiac action potential and electrocardiogram. A causal relationship between several such abnormalities and the panoply of sodium channel mutations have led to a greater understanding of the molecular underpinnings of cardiac arrhythmias as well as a deeper appreciation for the intricacies of sodium channel function. Here, we review the literature regarding these causal relationships from a perspective of the biophysical properties of sodium channels.