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      Autonomic Patterns Preceding and Following Accelerated Idioventricular Rhythm in Acute Myocardial Infarction

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          Abstract

          Introduction: We have investigated the potential relationship between cardiac autonomic activity and accelerated idioventricular rhythm (AIVR) in response to reperfusion in the setting of an acute myocardial infarction (AMI) through spectral analysis of heart rate variability (HRV). Methods and Results: We studied 16 patients with AMI who developed spontaneous sustained AIVR after initiation of intravenous thrombolysis. Sympathovagal interactions were evaluated by analysis of the low- (LF) and high-frequency (HF) spectral components of HRV for each 5-min interval over the 30-min periods preceding and following AIVR. The occurrence of AIVR was related to the ST-segment elevation resolution and the angiographic evidence of restored coronary flow to assess timely reperfusion and sustained coronary artery patency. The analysis of spectral components over time revealed combined responses of both autonomic limbs preceding and following AIVR, which were not followed by corresponding changes in heart rate. Ten minutes before AIVR, there was a characteristic continuous increase in LF, in the setting of a concomitant withdrawal of HF, suggestive of a progressive sympathetic predominance. After the end of AIVR, the opposite pattern was found with an increased HF and decreased LF, indicative of parasympathetic rebound overactivity. All patients showed signs of fast reperfusion and complete restoration of coronary flow. Conclusion: Our results indicate that reperfusion-induced AIVR is modulated by sympathetic stimulatory effects, whereas a counterregulatory vagal response seems to exert a profound effect upon its suppression. Clinically, the occurrence of early sustained AIVR appears to offer reliable information about both timely reperfusion and sustained and effective coronary artery patency.

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          Most cited references 2

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          Autonomic nervous system and sudden cardiac death.

          In the United States, sudden cardiac death is a major public health problem, accounting for approximately 300,000 deaths annually. Accurate identification of those patients at highest risk for this event has been problematic. The use of signal-averaged electrocardiography, Holter monitoring and assessment of left ventricular function have been shown to be predictive of future arrhythmic events in patients after a myocardial infarction. However, the clinical utility of these tests has been limited by their low sensitivity and positive predictive value. It has become increasingly clear that the autonomic nervous system is extremely important in the pathogenesis of ventricular arrhythmias and sudden cardiac death. The two most important techniques used to study the autonomic nervous system--heart rate variability and baroreflex sensitivity--are reviewed, and the clinical and experimental data suggesting that these techniques are powerful predictors of future arrhythmic events are discussed in depth.
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            Heart Rate Variability as a Marker of Myocardial Perfusion

            RR variability (HRV), an independent predictor of death following myocardial infarction, may also be related to other features of coronary artery disease. We evaluated its ability to differentiate among sedentary patients with chest pain ≥45 years of age demonstrating either normal or abnormal myocardial perfusion with rest and exercise thallium-210 tomographic imaging. The major HRV difference between 48 men and 50 women with normal perfusion was a significantly higher high frequency power in women. No significant differences in mean HRV values were found between the 57 men with abnormal perfusion scans and the 48 men with normal perfusion. In both men and women with normal perfusion scans, duration of exercise was significantly related to age. In men with abnormal scans, impaired myocardial perfusion alters the relationship between exercise duration and age, and a group of individuals with diminished HRV and low levels of physical fitness, regardless of age, can be identified. Despite these latter selective findings, we conclude that HRV is not a sensitive indicator to differentiate patients with normal and abnormal myocardial perfusion.
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              Author and article information

              Journal
              CRD
              Cardiology
              10.1159/issn.0008-6312
              Cardiology
              S. Karger AG
              0008-6312
              1421-9751
              2001
              November 2001
              08 November 2001
              : 96
              : 1
              : 24-31
              Affiliations
              Cardiology Division, Patras University Medical School, Patras, Greece
              Article
              47382 Cardiology 2001;96:24–31
              10.1159/000047382
              11701937
              © 2001 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 2, Tables: 2, References: 36, Pages: 8
              Categories
              General Cardiology

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