La Rovere M T, Mortara A, Pantaleo P, Maestri R, Cobelli F, Tavazzi L
Division of Cardiology and Bioengineering, Centro Medico Montescano, IRCCS, Fondazione Clinica del Lavoro, Pavia, Italy.
Circulation. 1994 Aug;90(2):838-43. doi: 10.1161/01.cir.90.2.838.
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.
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.
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.
充血性心力衰竭患者的交感神经过度活跃和副交感神经功能减退与疾病严重程度及总体生存率密切相关。药物对自主神经功能障碍的调节作用可能有助于提高生存率。低剂量东莨菪碱对正常受试者和急性心肌梗死后患者具有拟迷走神经作用。我们评估了透皮东莨菪碱是否会增加充血性心力衰竭患者的迷走神经活性。
对21例中重度心力衰竭患者在基线、使用一片透皮东莨菪碱24小时后及停用东莨菪碱48小时后进行心率变异性评估。东莨菪碱增加了心率变异性的时域和频域参数。具体而言，平均RR间期及其标准差分别增加了5.5%（P <.001）和45%（P <.001）。在用平均心率校正后，变异系数增加39%（P <.01），变化仍具有显著性。高频成分的绝对功率也显著增加。停用东莨菪碱后所有参数均恢复至基线水平。个体分析显示，在7例东莨菪碱未增加平均RR间期的患者中，心率变异性未发生变化。
通过心率变异性评估，透皮东莨菪碱可增加充血性心力衰竭患者的迷走神经活性。这种自主神经调节并非在所有患者中都出现，并且可以通过RR间期变化来预测。这种自主神经平衡的恢复在充血性心力衰竭患者的长期管理中是否具有有益作用仍有待确定。
