The roles of the Na+/H+ exchange system in the development and cessation of reperfusion induced ventricular arrhythmias were studied in the isolated perfused rat heart. The hearts were perfused in the working heart mode with modified Krebs Henseleit bicarbonate (KHB) buffer and whole heart ischemia was induced by a one-way ball valve with 330 beat/min pacing. Ischemia was continued for 15 min followed by 20 min of aerobic reperfusion (control). Amiloride (1.0 mM), an inhibitor of the Na+/H+ exchange system, was added to the KHB buffer only during reperfusion (group B) or only during ischemic periods (group C). Electrocardiographic and hemodynamic parameters were monitored throughout the perfusion. Coronary effluent was collected through pulmonary artery cannulation and PO2, PCO2, HCO3- and pH were measured by blood-gas analyzer. The incidence of reperfusion induced ventricular arrhythmias was 100%, 100% and 0% in control, group B and group C, respectively. The mean onset time of termination of reperfusion arrhythmias was significantly shorter in group B than in control. PCO2 increased from 39.0 +/- 0.9 to 89.3 +/- 6.0 mmHg at the end of ischemia in control and from 40.6 +/- 0.4 to 60.5 +/- 5.8 in group C, the difference between groups was statistically significant. HCO3- level decreased from 21.8 +/- 0.1 to 18.3 +/- 0.5 mmol/l in control, however, this decrease was significantly inhibited in group C (from 22.0 +/- 0.5 to 20.3 +/- 0.2). The increase in PCO2 and the decrease in HCO3- in group B were similar over time to those observed in control.(ABSTRACT TRUNCATED AT 250 WORDS)