Circulation, Vol 90, 838-843, Copyright © 1994 by American Heart Association
MT La Rovere, A Mortara, P Pantaleo, R Maestri, F Cobelli and L Tavazzi
BACKGROUND: Sympathetic hyperactivity and parasympathetic withdrawal in
patients with congestive heart failure correlate closely with disease
severity and overall survival. The modulating effects of drugs on the
autonomic dysfunction may contribute to improve survival. Low-dose
scopolamine has a vagomimetic effect in normal subjects and patients after
acute myocardial infarction. We assessed whether transdermal scopolamine
would increase vagal activity in patients with congestive heart failure.
METHODS AND RESULTS: Heart rate variability was assessed at baseline, 24
hours after one patch of transdermal scopolamine, and 48 hours after
scopolamine withdrawal in 21 patients with moderate to severe heart
failure. Scopolamine increased both time- and frequency- domain parameters
of heart rate variability. Specifically, the mean RR interval and its SD
increased by 5.5% (P < .001) and 45% (P < .001), respectively. The
change remained significant when corrected for mean heart rate with a 39%
(P < .01) increase of the coefficient of variation. The absolute power
of the high-frequency component was also significantly augmented. All the
parameters returned to baseline after scopolamine withdrawal. Individual
analysis showed that in the 7 patients in whom scopolamine did not increase
mean RR interval, heart rate variability did not change. CONCLUSIONS:
Transdermal scopolamine increases vagal activity as assessed by heart rate
variability in patients with congestive heart failure. This autonomic
modulation does not occur in all patients and can be predicted by RR
interval changes. Whether such restoration of the autonomic balance might
have beneficial effects in the long-term management of patients with
congestive heart failure remains to be determined.
ARTICLES
Scopolamine improves autonomic balance in advanced congestive heart failure
Division of Cardiology and Bioengineering, Centro Medico Montescano, IRCCS, Fondazione Clinica del Lavoro, Pavia, Italy.
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