Abstract
In 41 survivors of acute myocardial infarction (AMI) a prospective study was performed In 2 sequential phases. In phase 1, the role of beroreflex sensitivity and heart rate variability as predictors of Inducible and spontaneous sustained ventricular tacryarrhythmias was evaluated. In phase 2, the effects of trarurdenmal scopolamine on baroreflex sensitivity, spectral and nonspectral measures of heart rate variability were investigated. At a mean follow-up of 10 ± 3 months after AMI, 5 of 41 patients (12%) developed a late arrhythmic event. Of these, all (100%) had inducibility of sustained monomorphic ventricular tachycardia at programmed stimulation compared with 3 of 36 patients (8%) without events (p -0.0001). At multivariate analysis, baroreflex sensitivity had the strongest relation to both Inducibility of sustained monomorphic ventricular tachycardia (p <0.0001) and occurrence of arrhythmic events (p <0.0001). Of 41 patients, 28 (68%) consented to undergo phase 2 of the investigation. Baroreflex sensitivity significantly (p <0.00001) increased after transdermal scopolamine as well as heart rate variability indexes. Of these, the mean of 8Ds of normal RR Intervals for 5-minute segments (p <0.0001) and the total power (p <0.0001) had the most significant improvement after scopolarnine. The present investigation confirms that assessment of autonomic function is an essential part of arrhythmic risk evaluation after AMI. Transdenmal scopolamine, administered to survivors of a recent AMI, reverses the autonomic indexes that independently predict arrhythmic event occrurence. On the basis of these data, transdennal scopolamine could be a potential useful tool in the prophylaxis of life-threatening ventricular arrhythimias after AMI.
Published Version
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