Circulation, Vol 88, 353-357, Copyright © 1993 by American Heart Association
B Casadei, A Pipilis, F Sessa, J Conway and P Sleight
BACKGROUND. Reduced cardiac vagal tone in patients with myocardial
infarction (MI) is associated with a high risk of sudden death. Muscarinic
blocking agents in small doses induce a paradoxical increase in cardiac
vagal activity in normal subjects. We tested whether low doses of
scopolamine delivered transdermally enhance tonic and reflex cardiac vagal
activity in patients in the acute phase of MI. METHODS AND RESULTS.
Patients were randomized to a scopolamine (n = 17) or a placebo patch (n =
19) in a double-blind fashion 4.20 +/- 0.18 days after acute MI. Cardiac
vagal activity was assessed by testing the arterial baroreflex sensitivity
(BRS) using the phenylephrine method and by power spectral analysis of the
RR interval variability. Twenty- four hours after scopolamine, we found a
significant increase in BRS (from 7.05 +/- 1.21 to 13.99 +/- 2.33 ms/mm Hg,
P < .05) and in RR variability, expressed as the mean standard deviation
of 512 normal consecutive RR intervals (from 18.09 +/- 2.64 to 31.16 +/-
4.16 milliseconds, P < .05). The amplitude of respiratory sinus
arrhythmia, measured by the absolute power of the high-frequency spectral
component, was also enhanced (from 62.55 +/- 21.49 to 305.33 +/- 95.68
milliseconds squared, P < .05), whereas the power in the low-frequency
spectral component of the RR variability, which results from the
interaction between cardiac sympathetic and vagal activity, did not change
significantly (from 73.12 +/- 24.44 to 126.46 +/- 44.29 milliseconds
squared, P = .93). CONCLUSIONS. In patients in the acute phase of MI, low
doses of scopolamine cause a sustained increase in cardiac vagal tone and
improve the autonomic indices associated with mortality.
ARTICLES
Low doses of scopolamine increase cardiac vagal tone in the acute phase of myocardial infarction
Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, England, UK.
This article has been cited by other articles:
 |
|
 |
|
  G. E. Billman Cardiac autonomic neural remodeling and susceptibility to sudden cardiac death: effect of endurance exercise training Am J Physiol Heart Circ Physiol, October 1, 2009; 297(4): H1171 - H1193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Brack, V. H. Patel, R. Mantravardi, J. H. Coote, and G. A. Ng Direct evidence of nitric oxide release from neuronal nitric oxide synthase activation in the left ventricle as a result of cervical vagus nerve stimulation J. Physiol., June 15, 2009; 587(12): 3045 - 3054. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Jankowska, P. Ponikowski, M. F. Piepoli, W. Banasiak, S. D. Anker, and P. A. Poole-Wilson Autonomic imbalance and immune activation in chronic heart failure - Pathophysiological links Cardiovasc Res, June 1, 2006; 70(3): 434 - 445. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. E. Billman and M. Kukielka Effects of endurance exercise training on heart rate variability and susceptibility to sudden cardiac death: protection is not due to enhanced cardiac vagal regulation J Appl Physiol, March 1, 2006; 100(3): 896 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Dunlap, S. Bibevski, T. L. Rosenberry, and P. Ernsberger Mechanisms of altered vagal control in heart failure: influence of muscarinic receptors and acetylcholinesterase activity Am J Physiol Heart Circ Physiol, October 1, 2003; 285(4): H1632 - H1640. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. E. Billman Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention J Appl Physiol, February 1, 2002; 92(2): 446 - 454. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Bernardi, C. Porta, L. Spicuzza, J. Bellwon, G. Spadacini, A. W. Frey, L. Y.C. Yeung, J. E. Sanderson, R. Pedretti, and R. Tramarin Slow Breathing Increases Arterial Baroreflex Sensitivity in Patients With Chronic Heart Failure Circulation, January 15, 2002; 105(2): 143 - 145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kruger, V. Landerer, C. Zugck, H. Ehmke, W. Kubler, and M. Haass The bradycardic agent zatebradine enhances baroreflex sensitivity and heart rate variability in rats early after myocardial infarction Cardiovasc Res, March 1, 2000; 45(4): 900 - 912. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Zipes and H. J. J. Wellens Sudden Cardiac Death Circulation, November 24, 1998; 98(21): 2334 - 2351. [Full Text] [PDF]
|
|
|
|
|
|
N. Montano, C. Cogliati, A. Porta, M. Pagani, A. Malliani, K. Narkiewicz, F. M. Abboud, C. Birkett, and V. K. Somers Central Vagotonic Effects of Atropine Modulate Spectral Oscillations of Sympathetic Nerve Activity Circulation, October 6, 1998; 98(14): 1394 - 1399. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Laitinen, J. Hartikainen, E. Vanninen, L. Niskanen, G. Geelen, and E. Lansimies Age and gender dependency of baroreflex sensitivity in healthy subjects J Appl Physiol, February 1, 1998; 84(2): 576 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Coupland, S. Wilson, and D. Nutt Antidepressant drugs and the cardiovascular system: a comparison of tricylics and selective serotonin reuptake inhibitors and their relevance for the treatment of psychiatric patients with cardiovascular problems J Psychopharmacol, January 1, 1997; 11(1): 83 - 92. [PDF]
|
|
|
|
|
|
T. F. o. t. E. S. o. C. t. N. A. S. o. P. Electrophysiology Heart Rate Variability : Standards of Measurement, Physiological Interpretation, and Clinical Use Circulation, March 1, 1996; 93(5): 1043 - 1065. [Full Text]
|
|
|
|
|
|
S. S. Hull Jr, E. Vanoli, P. B. Adamson, G. M. De Ferrari, R. D. Foreman, and P. J. Schwartz Do Increases in Markers of Vagal Activity Imply Protection From Sudden Death? : The Case of Scopolamine Circulation, May 15, 1995; 91(10): 2516 - 2519. [Abstract] [Full Text]
|
|