The homeodomain transcription factor Irx5 establishes the mouse cardiac ventricular repolarization gradient

Rhythmic cardiac contractions depend on the organized propagation of depolarizing and repolarizing wavefronts. Repolarization is spatially heterogeneous and depends largely on gradients of potassium currents. Gradient disruption in heart disease may underlie susceptibility to fatal arrhythmias, but it is not known how this gradient is established. We show that, in mice lacking the homeodomain transcription factor Irx5, the cardiac repolarization gradient is abolished due to increased K_v4.2 potassium-channel expression in endocardial myocardium, resulting in a selective increase of the major cardiac repolarization current, I_to,f, and increased susceptibility to arrhythmias. Myocardial Irx5 is expressed in a gradient opposite that of K_v4.2, and Irx5 represses K_v4.2 expression by recruiting mBop, a cardiac transcriptional repressor. Thus, an Irx5 repressor gradient negatively regulates potassium-channel-gene expression in the heart, forming an inverse I_to,f gradient that ensures coordinated cardiac repolarization while also preventing arrhythmias. Copyright ©2005 by Elsevier Inc.