Evidence map›Paper›PMID 42454413›Full record

ArticleCirculation research2026

Cardiac Pacemaker Cells Harness Stochastic Resonance to Avoid Sinus Arrest.

Akihiro Okamura, Isabella K He, Alexander V Maltsev, Rostislav Bychkov, Syevda Tagirova, Michael Wang, Anna V Maltsev, Michael D Stern, Edward G Lakatta, Victor A Maltsev

Abstract read
In one paragraph

Article in Circulation research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Akihiro Okamura *National Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).
Isabella K He *National Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).
Alexander V MaltsevNational Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).
Rostislav BychkovNational Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).
Syevda TagirovaNational Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).
Michael WangNational Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).ORCID 0009-0001-9672-0891
Anna V MaltsevSchool of Mathematics, Queen Mary University of London, United Kingdom (Anna V. Maltsev).ORCID 0000-0003-4139-1004
Michael D SternNational Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).ORCID 0000-0003-4476-7425
Edward G LakattaNational Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).ORCID 0000-0002-4772-0035
Victor A MaltsevNational Institute on Aging, NIH, Baltimore, MD (A.O., I.K.H., Alexander V. Maltsev, R.B., S.T., M.W., M.D.S., E.G.L., V.A.M.).ORCID 0000-0002-3832-791X

Funding

Intramural NIH HHS Z99 AG999999
6 · The paper itself

Abstract

backgroundThe sinoatrial node (SAN) is the primary pacemaker of the heart. Recent high-resolution imaging showed that synchronized action potentials exiting the SAN emerge from heterogeneous signals, including subthreshold signals in nonfiring (dormant) cells. This raises a new question in cardiac biology: how do these signals contribute to heartbeat generation? Here, we tested the hypothesis that pacemaker cells harness stochastic resonance to ensure fail-safe operation, especially at low rates bordering on sinus arrest.

methodsMembrane potential and Ca signals were measured using perforated-patch recordings in rabbit SAN cells exposed to sine-wave or white-noise currents. In addition, we imaged Ca signals in intact mouse SAN tissue and performed multiscale model simulations at the subcellular, cellular, and tissue levels.

resultsIn addition to synchronized Ca transients, SAN tissue exhibited heterogeneous local Ca signals with different kinetics. Noise currents, mimicking the heterogeneous natural cellular environment, restored action potential firing in dormant cells and substantially improved the rate and rhythm of cells firing infrequently and irregularly. Performance followed a bell-shaped curve, peaking and then declining, demonstrating a hallmark of stochastic resonance. Rhythmic action potential generation in response to sine-wave currents of different frequencies defined a resonance spectrum in SAN cells, reflecting their ability to respond via stochastic resonance to specific frequency components embedded in noise. Cholinergic stimulation shifted the resonance spectrum and responses to noise toward lower frequencies across all amplitudes tested, rendering cells unresponsive to higher-frequency signals while enabling more effective processing of slower signals. Both the numerical models and simultaneous recordings of membrane potential and Ca dynamics demonstrated that stochastic resonance is amplified by coupled electrical and Ca signaling, enhancing action potential generation at low noise levels. Adding noise currents to the cell and tissue numerical models allowed firing under conditions in which they otherwise would have stopped.

conclusionsSAN cells harness stochastic resonance amplified by coupled membrane-Ca signaling to ensure rhythmic heartbeat initiation, especially at low rates. This new signaling mechanism may help avoid sinus arrest when the heart slows and biological noise increases, such as during parasympathetic stimulation, bradyarrhythmia, or aging.

Indexed as

Biological ClocksCalcium SignalingHeart RateMyocytes, CardiacSinoatrial NodeAction PotentialsAnimalsComputer SimulationMiceModels, CardiovascularRabbitsStochastic Processesaction potentialsbradycardiamicerabbitsreceptors, cholinergicsick sinus syndromesinoatrial node

Identifiers

PMID42454413
PMCPMC13502193

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.