Autonomic Balance In Patients Research Articles

Clinical characteristics and autonomic balance in patients with burning mouth syndrome: A retrospective chart review.

This study aimed to identify the clinical characteristics of patients with burning mouth syndrome (BMS) according to the low frequency/high frequency (LF/HF) ratio in the heart rate variability test and to evaluate the potential of the LF/HF ratio as an indicator for the diagnostic or predictive assessment of patients with BMS. A total of 469 patients with BMS who visited the Oral Diseases Clinic of Kyung Hee University Korean Medicine Hospital between January 1, 2018, and December 31, 2022, were included in the study. The patients were asked to rate their tongue pain on a visual analog scale before and after treatment. Heart rate variability testing and measurement of the unstimulated and stimulated salivary flow rates were conducted. The patients were divided into 3 groups according to their LF/HF ratios. Clinical characteristics, including tongue pain, salivary secretion, and concomitant symptoms, were compared between the groups. Spearman correlation analysis was performed to determine any significant correlation between the LF/HF ratio and the clinical symptoms. The patients were also classified into 2 groups according to psychological factors to analyze their effects on the clinical characteristics of BMS. The pretreatment pain score (PRPS), posttreatment pain score (POPS), and incidence rate of dry mouth symptoms were higher in the parasympathetically activated group than in the other groups. Spearman correlation analysis revealed a negative correlation between the LF/HF ratio and the PRPS. The PRPS and POPS were higher and the unstimulated salivary flow rate, stimulated salivary flow rate, and LF/HF ratio were lower in the group with psychological factors than in the group without psychological factors. The parasympathetic group reported higher PRPS and POPS and a higher incidence of dry mouth symptoms. This may be attributable to the role of psychological factors in BMS, which is a functional pain disorder. The different clinical characteristics based on the LF/HF ratio indicate that the LF/HF ratio may serve as a significant indicator for diagnosing or predicting the prognosis of patients with BMS.

Renal sympathetic denervation improves heart rate variability and reduces arrhythmia burden

Abstract Background Decreased heart rate variability (HRV) is a strong predictor of mortality (particularly sudden death), not only in high-risk patients. The impact of renal denervation (RDN) on HRV and cardiac arrhythmias has not yet been fully investigated. Purpose To assess the effect of RDN on HRV and cardiac arrhythmias in patients with blood pressure (BP) >160/100 mmHg despite 3 full-dose antihypertensive drugs. Methods The study included 108 patients (46.3% male) with resistant hypertension (RH), the average age was 50.5±9.0. All patients underwent RDN. Procedure was performed by an experienced electrophysiologist at the renal arteries using specialized electrode Symplicity Flex: ablation power = 8–10 W at 55°C, 4–10 points for each renal artery (including brunch, when was appropriate), 2 minutes per point. Office systolic BP (SBP) and diastolic BP (DBP), 24-hour ambulatory BP monitoring and 24-hour monitoring ECG were measured before, at 6 and 12 months of follow-up. Results Baseline SBP and DBP in these groups of patients were −185.6±29 and −110.5±19.3 mm Hg respectively. Office BP significantly decreased by −28.2±21.6 /18.0±16.7 mm Hg (p<0.001 for both) at 12 month. 24-hour SBP and DBP was significantly reduced both at 6 and 12 months after RDN. Twenty-four-hour BP was reduced by 13.2/8.4mmHg (P<0.001). The number and dosage of antihypertensive drugs remained unchanged in all patients. Baseline data of general HRV in this group of patients were low: SDNN – 123.4±41.4 msec. The general HRV increased at 12 month since RDN: SDNN from 123.4±41.4 msec to 155.8±51.4 msec (p<0.05), SDANN-i from 105.3±42.7 msec to 122.1±41.1 msec (p<0.05). There was observed increase in RMSSD, reflecting of parasympathetic activity of autonomic nervous system – from 29.7±43.6 msec to 41.1±33.2 msec (p<0.05). The total number of premature supraventricular and ventricular contractions was also significantly decreased both at 6 and at 12 months after RDN (p<0.05 for both cases). Mean 24-hour monitoring heart rate was reduced by 5.8 bpm (p=0.02) at 12 month after RDN. No pauses or conduction abnormalities were observed either at baseline or after RDN. Conclusions Besides the important effect of RDN on heart rate and arrhythmic events, a significant improvement the time domain indexes of HRV was evident in patients with resistant hypertension at 12 month after the RDN-procedure. Our prospective single center study shows that RDN results in substantial BP lowering, significant reduction of mean heart rate and arrhythmia burden and restores autonomic balance in patients with resistant uncontrolled hypertension. Funding Acknowledgement Type of funding source: None

Increased Heart Rate Variability following Elective Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease and Preprocedural Anxiety.

Background There is a strong association between chronic ischemia and autonomic imbalance. Percutaneous coronary intervention (PCI) may restore autonomic balance in patients with stable coronary artery disease (SCAD), which is characterized by increased heart rate variability (HRV). Anxiety is often found in patients who are going to undergo invasive procedures and has been identified to induce autonomic imbalance. The aim of our study is to identify the impact of preprocedural anxiety on increased HRV following an elective PCI. Methods Our study was a pretest and post-test correlation study involving 44 SCAD patients who underwent elective PCI at Cipto Mangunkusumo National Hospital. The HRV was measured before and after PCI. Anxiety symptoms were evaluated using Hospital Anxiety Depression Score (HADS) questionnaires. Results We found a higher increase on HRV parameter following the PCI of subjects in the nonanxiety group compared with the anxiety group (median = 9.11 vs. 2.83; U = 154.00; p=0.043). Conclusions Preprocedural anxiety may inhibit HRV increase following PCI procedure.

Impact of personality-oriented programs of physical rehabilitation on the heart rate variability in women with post-mastectomy syndrome

AbstractIntroduction. The aim of the study was to determine the effect of personality-oriented physical rehabilitation programs on the heart rate variability in women with post-mastectomy syndrome. Methods. The following methods were applied: theoretical analysis of scientific and methodologic literature data, heart rate variability analysis, and mathematical statistical methods. The subjects of the study were 50 women with late symptoms of post-mastectomy syndrome. The study was conducted during the ambulatory rehabilitation stage after Madden radical mastectomy. All the indicators of the heart rate variability were equivalent in the main and comparison groups at the beginning of rehabilitation. The impact of training was examined every 6 months over the course of a year. Results. Measurements were taken three times: at the beginning of rehabilitation and after 6 and 12 months. It was found that most of the investigated parameters of heart rate variability in both groups steadily improved during the year of rehabilitation. The average values of stress index and amplitude of mode after 12 months of rehabilitation were lower in the main group than in the comparison group but the values of the standard deviation of normal-to-normal intervals and the very low-frequency component of the spectrum were better by 6.48 ms (p < 0.05) and 203.29 ms2 (p < 0.05), respectively. Conclusions. The personality-oriented programs of physical rehabilitation were effective in augmenting heart rate variability and restoring autonomic balance in patients with post-mastectomy syndrome.

The exercise training restores the heart rate variability in heart failure patients. A systematic review

A systematic literature review was conducted in electronic databases. The considered studies were randomised clinical trials, quasi-experimental studies with non-randomised control group, quasi-experimental studies with analysis of pre- and post- intervention, and crossover studies with randomly assigned training and non-training periods. The standardised mean differences were calculated between pre- and post-intervention in both the control and experimental group. Within-subject analysis of the control group showed no statistical significance in the standardised mean differences of HRV. In the experimental group, the standardised mean differences were positive for the root mean square of successive difference (+0.468±0.215; P=.032), high frequency band (HF) (0.934±0.256; P < .001) and low frequency band (LF) (< 0.415±0.096; P=.001). Moreover, the standardised mean difference was negative for LF/HF (-0.747±0.369, P=<.044). On the other hand, only 3 studies entered the comparative meta-analysis. The effect of exercise training was favourable for the experimental group in LF/HF (-2.21±95% CI: -3.83 to -0.60), HF, and LF. The exercise training was effective in increasing HRV and restoring the autonomic balance in patients with heart failure.

Effects of Exercise Training on Autonomic Function in Chronic Heart Failure: Systematic Review.

Objectives. Cardiac autonomic imbalance accompanies the progression of chronic heart failure (CHF). It is unclear whether exercise training could modulate autonomic control in CHF. This study aimed to review systematically the effects of exercise training on heart rate recovery (HRR) and heart rate variability (HRV) in patients with CHF. Methods. Literatures were systematically searched in electronic databases and relevant references. Only published randomized controlled trials (RCTs) focusing on exercise training for CHF were eligible for inclusion. Outcome measurements included HRR and HRV parameters. Results. Eight RCTs were eligible for inclusion and provided data on 280 participants (186 men). The participants were 52–70 years of age with New York Heart Association functional class II-III of CHF. Each study examined either aerobic or resistance exercise. Two trials addressed outcome of HRR and six HRV among these studies. Two RCTs showed that moderate aerobic exercise could improve HRR at 2 minutes after exercise training in CHF. Five of six RCTs demonstrated positive effects of exercise training on HRV which revealed the increments in high frequency (HF) and decrements in LF (low frequency)/HF ratio after training. Conclusion. Participation in an exercise training program has positive effects on cardiac autonomic balance in patients with CHF.

ИЗМЕНЕНИЕ ПОКАЗАТЕЛЕЙ ВАРИАБЕЛЬНОСТИ СЕРДЕЧНОГО РИТМА В РАННЕМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ КОРОНАРНОГО ШУНТИРОВАНИЯ

The aim of the research. Estimation of daily dynamics of the indicators variability for temporal analysis of heart rate (HRV) in patients with coronary heart disease (CHD) in the preoperative and early postoperative period of coronary artery bypass grafting (CABG). Materials and methods. Were examined 38 patients with coronary heart disease aged from 42 to 71 years old. HRV was assessed by 24-hour ECG monitoring conducted before CABG in the 1st and the 8th day after CABG. The Results. In the preoperative period in patients with ischemic heart disease was observed ratio of the temporal analysis of HRV during wakefulness and sleep, which is characteristic for healthy individuals. In the 1st and the 8th day after CABG was observed decrease in parasympathetic effects on the myocardium at night, more pronounced in patients with left ventricular aneurysm. Conclusion. The revealed changes of autonomic balance in patients with coronary artery disease may be relevant to the treatment of patients in early period after CABG.

Assessment of Autonomic Nervous System Status in Severe Iron Deficiency Anemia Patients Using Valsalva Maneuver

Background: The present study was conducted to find out whether the Valsalva test and thus the autonomic nervous system are affected in patients of severe iron deficiency anemia. Materials and methods: In this study the change in heart rate was recorded with the help of ECG machine during and after the valsalva maneuver. The change in heart rate was compared between 60 patients of severe iron deficiency anemia and 60 ages and socioeconomically matched normal subjects. Result: It was found that the change in heart rate was significantly altered in patients of severe iron deficiency anemia (p<0.0001) when compared to controls. Conclusion: The present study demonstrates an altered autonomic balance in patients with true iron deficiency anemia.

Differences in autonomic balance in patients with cardioinhibitory and vasodepressor type of reflex syncope during head-up tilt test and active standing

Objective. To improve the pathophysiological understanding of cardioinhibitory and vasodepressor reflex syncope, by evaluating orthostatic effects on electrical and hemodynamic variables. To unravel the pathogeneses further, we studied these effects during both the passive head-up tilt test and the active standing test. Background. The current knowledge of the compromised autonomic balance in patients with reflex syncope is limited. The orthostatic responses to head-up tilt test in cardioinhibitory and vasodepressor patients differ, suggesting different pathogeneses; however, the more physiological active standing test represents daily life situations better. Methods. We included 74 patients; 36 cardioinhibitory and 38 vasodepressor. Patients were compared with respect to vascular hemodynamics and heart rate variability during the change from supine to upright position. Resting electrolytes, brain natriuretic peptide (BNP), pro-atrial natriuretic peptide (pro-ANP), and the C-terminal of pro-vasopressin, copeptin were measured. Results. Resting systolic blood pressure was higher in cardioinhibitory (117.8 ± 15.7 mmHg) than in vasodepressor patients (109.1 ± 15.3 mmHg, p < 0.001). Changes in heart rate tended to be smaller in cardioinhibitory patients (6.7 ± 9.8vs. 10.7 ± 8.9 bpm, p = 0.056). Heart rate variability was lower and changed less in cardioinhibitory patients (p < 0.05). Cardioinhibitory patients had higher pro-ANP levels (63.5 ± 18.8pM) compared to vasodepressor patients (54.2 ± 31.4 pM, p = 0.018). Responses during active standing were attenuated compared to head-up tilt in both groups. Conclusions. This study demonstrated that cardioinhibitory patients had higher blood pressure, attenuated hemodynamic responses, and reduced autonomic regulation compared to vasodepressor patients. Furthermore, cardioinhibitory patients showed a sympathetic predominance in their modulation of autonomic responses. Orthostatic responses induced by active standing were modest and did not sufficiently explain potential pathophysiological differences between cardioinhibitory and vasodepressor patients.

Heart rate variability in children with acute rheumatic fever

Acute rheumatic fever is a systemic inflammatory disease occurring after acute streptococcal tonsillopharyngitis. The PR prolongation in these patients is thought to be due to increased vagal activity. There has been no previous study investigating the autonomic balance in patients with acute rheumatic fever. In this study, we aimed to investigate the balance of the autonomic nervous system in children with acute rheumatic fever by analysis of heart rate variability. We evaluated the heart rate variability parameters in 50 patients with acute rheumatic fever and 37 comparable control subjects. Both groups underwent 24-hour electrocardiography monitoring, and time- and frequency-domain heart rate variability parameters were calculated. A total of 39 patients (78%), with (n = 28) or without (n = 11) other major findings, had carditis, and the remaining 11 (22%) did not. The PR interval was found to be prolonged in 10 (20%) of the patients at the beginning. In the study group, the time- and frequency-domain heart rate variability parameters showed a sympathetic dominance compared with the control group, with a p-value less than 0.05. When compared with the control group, the time- and frequency-domain heart rate variability parameters showed a significant sympathetic dominance in patients with both prolonged PR and normal PR intervals in the acute period, with a p-value less than 0.05. When compared with patients with normal PR interval, mean normalised low frequency and normalised high frequency parameters suggested a relatively lower sympathetic dominance in patients with prolonged PR interval, with a p-value less than 0.05. Our results indicated that in the acute period of rheumatic fever, sympathetic dominance is apparent; in patients with prolonged PR interval, sympathetic dominance is relatively lower when compared with the patients with normal PR interval.

Differences in autonomic balance in patients with cardioinhibitory and vasodepressor type of reflex syncope during head-up tilt test and active standing

Objective. To improve the pathophysiological understanding of cardioinhibitory and vasodepressor reflex syncope, by evaluating orthostatic effects on electrical and hemodynamic variables. To unravel the pathogeneses further, we studied these effects during both the passive head-up tilt test and the active standing test. Background. The current knowledge of the compromised autonomic balance in patients with reflex syncope is limited. The orthostatic responses to head-up tilt test in cardioinhibitory and vasodepressor patients differ, suggesting different pathogeneses; however, the more physiological active standing test represents daily life situations better. Methods. We included 74 patients; 36 cardioinhibitory and 38 vasodepressor. Patients were compared with respect to vascular hemodynamics and heart rate variability during the change from supine to upright position. Resting electrolytes, brain natriuretic peptide (BNP), pro-atrial natriuretic peptide (pro-ANP), and the C-terminal of pro-vasopressin, c...

Changes in autonomic balance in patients with decompensated chronic heart failure

In chronic heart failure (CHF) episodes of decompensation may be linked to derangements within cardiovascular reflex control. We investigated changes in autonomic tone in patients with decompensated CHF. We examined 17 patients with decompensated CHF (14 men, age 62±2years, LVEF 32±3%) on admission and after clinical stabilization. Control group consisted of 9 patients (8 men, age 64±7years, LVEF 30±7%) with stable CHF. Assessment of autonomic tone was based on 5-min ECG and blood pressure recordings using time and frequency domains of heart rate variability (HRV) and a sequence method to derive baroreflex sensitivity (BRS). On admission, decompensated CHF patients had reduced HRV indices (p<0.05) and depressed BRS (p<0.01) as compared to those with stable CHF. After clinical stabilization (4±2days of treatment) time domain HRV indices and BRS increased (SDNN, 34.4±5.4 vs. 55.8±9.8ms; RMSSD, 38.4±12.0 vs. 51.1±10.4ms; BRS, 4.3±0.7 vs. 7.6±1.3ms/mmHg; all p<0.01) and became similar to those seen in stable CHF patients. Breathing with oxygen affected autonomic indices neither in decompensated nor in stable CHF patients. Eight patients developed an episode of additional CHF worsening during hospitalization, in whom the third assessment was performed on discharge. Worsening in clinical status was followed by a decrease in HRV and BRS that became similar to those noted on admission. HRV measures and BRS are severely deranged in the acute phase of CHF decompensation. Clinical stabilization results in an improvement of autonomic indices. However, subsequent clinical worsening adversely affects HRV and BRS.

DYNAMICS OF THE HEART RATE VARIABILITY IN PATIENTS WITH ATRIAL FIBRILLATION DURING ATORVASTATIN THERAPY

Aim. To evaluate the heart rate variability (HRV) in patients with ischemic heart disease (IHD) and paroxysmal atrial fibrillation (AF) during atorvastatin therapy. Material and methods . 60 patients with IHD and paroxysmal AF were included in the study. Patients were divided into two groups – control group (basic antiarrhythmic therapy) and second group (basic antiarrhythmic therapy and atorvastatin (Liptonorm, Pharmstandart, Russia) 10mg/day). HRV was compared before and after 3 months of therapy in both groups. Results. Liptonorm significantly improved HRV indices in comparison with basic therapy alone: RMSSD increased on 33% (р &lt;0,02), total power (TP) of spectrum on 28% (р &lt;0,03) and high frequency (HF) component on 53 % (р &lt;0,01). Conclusion. Liptonorm therapy improves autonomic balance in patients with IHD and paroxysmal AF.

The Altered Autonomic Nervous System Activity in Iron Deficiency Anemia

Autonomic function is impaired in anemic patients with various etiologies such as vitamin B12 deficiency, sickle cell trait, and thalassemia major. However, there are insufficient data about autonomic functions in patients with iron deficiency anemia, the leading cause for anemia in the general population. In the present study we aimed to investigate the autonomic status in iron deficiency anemia by analyzing the heart rate variability (HRV). Age- and gender-matched 43 patients with iron deficiency anemia and 39 healthy subjects were undertaken into 24-hr Holter monitoring for assessing the HRV. We used serum levels of iron, iron binding capacity, C-reactive protein, vitamin B12, and folate to exclude other causes of anemia. While age, gender, vitamin B12 and folate levels were not different between the groups, HRV values were lower in patients with iron deficiency anemia compared to control group, which reflects parasympathetic withdrawal. Blood hemorheological factors such as decreased viscosity and/or altered red cell deformability may be responsible for this decreased parasympathetic activity. However, these components do not display remarkable contribution in iron deficiency anemia. Therefore, we speculated a probable link between anemia and the accentuated sympathetic activity that may be triggered by hypoxia sensed through carotid bodies. Despite lacking adequate convincing evidence concerning exact mechanism of carotid body activation, it is assumed as due either to hypoxia-related mitochondrial respiratory chain inhibition or potassium channel suppression that leads to intracellular calcium accumulation. In conclusion, the present study demonstrates an altered autonomic balance in patients with true iron deficiency anemia.

Autonomic imbalance during the day in patients with inflammatory bowel disease in remission. Evidence from spectral analysis of heart rate variability over 24 hours

Background. Autonomic function in inflammatory bowel disease has not yet been studied by means of analysis of 24-hour heart rate variability. Aim. To measure heart rate variability in inflammatory bowel disease patients in remission. Patients and methods. Study population comprised 27 patients with inflammatory bowel disease in remission and 28 healthy, sex- and age-matched controls. Two frequency ranges were analysed: low frequency (0.06–0.15 Hz) and high frequency (0.15–0.40 Hz). Results. Mean values of low frequency and low frequency/high frequency ratio were lower in patients than in controls (p<0.001). High frequency in patients tended to be higher than in controls (p=0.09). The only factor that had a marginal effect on heart rate variability indexes was age. In high frequency, there was a significant time effect (p=0.001) for both groups. There was also a significant time effect in low frequency/high frequency ratio in both groups (p<0.001). During daytime, the mean values in low frequency/high frequency ratio were lower in patients than in controls (p<0.001). Conclusions. There is a shift in the autonomic balance in patients with inflammatory bowel disease in remission towards a condition of relative parasympathetic predominance, which, in the first place, reflects a sympathetic pullback. This imbalance has a circadian rhythm and it is more pronounced during the day.

Impaired Endothelin-1 Release in Tilt-Induced Syncope

The neurohumoral events associated with neurocardiogenic syncope remain unclear. The simultaneous assessment of changes in endothelium-dependent and independent hormones and in autonomic balance in patients with tilt-induced syncope has been incompletely studied. Forty-six healthy subjects aged between 21 and 83 years (mean ± SEM 47 ± 3) underwent a 30-minute head-up tilt test at 60°. Fourteen subjects (10 females and 4 male subjects) exhibited syncope at 16 ± 2 minutes into the tilt. Hemodynamics were recorded every 5 minutes and blood samples for the measure of catecholamines, endothelin-1 (ET-1), and angiotensin-II (AT-II), were drawn at baseline, and 5, 10, 15, and 30 minutes into the tilt and immediately before syncope. Heart rate variability was analyzed by 5-minute segments during the test. Both catecholamines and ET-1 levels increased consistently in response to head-up tilt in subjects able to tolerate the test. Epinephrine increased to a greater extent before syncope. In contrast, ET-1 failed to increase at any time during the tilt and just before syncope. AT-II increased at 30 minutes into the tilt only in the control group. Finally, power in high-frequency bands decreased less in the group with syncope. Thus, compared with subjects able to tolerate a head-up tilt test, patients with syncope exhibit a greater increase in adrenomedullary activation, no significant increase in ET-1 levels, and a blunting in the decrease of vagal tone before syncope. The lack of increase in ET-1 during tilt may play a role in the inability to support orthostatic stress.

Selective AT-1 blockade with losartan does not restore autonomic balance in patients with heart failure

Selective AT-1 blockade with losartan does not restore autonomic balance in patients with heart failure

Sympathetic inhibition with clonidine improves autonomic balance in congestive heart failure

In this double-blind, placebo-controlled crossover study, we examined the effect of transdermal clonidine (given for 5 days) on autonomic control in 14 patients with mild to moderate congestive heart failure by heart rate variability analysis. Compared with placebo, clonidine increased the 24-h mean R-R interval from 718±110 to 811±117 ms ( P<0.01), increased the S.D. of all normal RR intervals (SDNN) from 60.8±18.5 to 80.9±21.4 ms ( P<0.01), the S.D. of the average RR intervals for all 5-min segments (SDANN) from 54.7±15.2 to 70.5±18.4 ms ( P<0.01) and the mean of the S.D.s of all RR intervals for all 5-min segments (SDNN index) from 29.2±8.3 to 36.5±8.1 ms ( P<0.01). The root mean square successive differences (r-MSSD) and the percent of differences between adjacent RR intervals >50 ms (pNN50) were also increased from 18.3±6.7 to 23.1±7.0 ms ( P<0.01) and from 2.1±1.9 to 4.5±3.0% ( P<0.01). In addition, total power, low frequency power and high frequency power were increased from 641±322 to 898±403 ms 2/Hz ( P<0.01), from 149±97 to 216±133 ms 2/Hz ( P<0.01) and from 52.8±27.1 to 93.2±41.3 ms 2/Hz ( P<0.01), respectively. The plasma norepinephrine level was decreased significantly from 0.52±0.18 to 0.24±0.09 ng/ml ( P<0.01) after clonidine therapy. Changes in heart rate variability measures after clonidine administration were positively related to changes in plasma norepinephrine level. These results indicate that suppressing the sympathetic nervous system by clonidine improves autonomic balance in patients with congestive heart failure. But whether such restoration of the autonomic control has a beneficial effect on the long-term management of these patients still needs further investigation.

Heart rate variability and autonomic balance in patients with different stages of severe congestive heart failure.

Heart rate variability and autonomic balance in patients with different stages of severe congestive heart failure.

Effect of transdermal scopolamine on heart rate variability in patients with severe coronary heart disease.

A decrease in cardiac parasympathetic tone is a recognized finding in patients with ischemic heart disease, correlating closely with disease severity and overall survival. The aim of this study was to assess whether transdermal scopolamine (Tds), which increases parasympathetic tone in healthy volunteers, increases vagal tone in patients with severe CAD and whether it might have an antiischemic effect. Fifteen patients (10 men, aged 55 +/- 8 years) with three-vessel CAD, but with no prior MI and preserved ventricular function, underwent 24-hour Holter monitoring and exercise testing before and after wearing a scopolamine patch for 24 hours. Time-domain measures of heart rate variability (HRV) and the total number and duration of ischemic episodes were obtained from the Holter recordings for each patient. Tds significantly (P < 0.05) increased the values of all HRV measures. Tds also reduced the total number of ischemic episodes (from 273 to 159, P < 0.05) and their total duration (from 136 to 46 min per patient, P < 0.05). Tds also increased treadmill exercise duration from 293 +/- 101 to 345 +/- 95 seconds (P < 0.05) and the time to 1-mm ST depression from 177 +/- 105 to 244 +/- 128 seconds (P < 0.02), while maximum ST depression was reduced from 2.86 +/- 0.6 to 2.3 +/- 0.3 (P < 0.05). No significant side effects were observed. Tds modifies the autonomic balance in patients with severe CAD toward a condition associated with a better prognosis. It may also be useful as an adjunctive treatment for ischemic heart disease.