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 wh ether transdermal scopolamine (Tds), which increases parasympathetic t one in healthy volunteers, increases vagal tone in patients with sever e CAD and whether it might have an antiischemic effect. Fifteen patien ts (10 men, aged 55 +/- 8 years) with three-vessel CAD, but with no pr ior MI and preserved ventricular function, underwent 24-hour Holter mo nitoring and exercise testing before and after wearing a scopolamine p atch 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 to tal 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 in creased treadmill exercise duration from 293 +/- 101 to 345 +/- 95 sec onds (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 reduc ed from 2.86 +/- 0.6 to 2.3 +/- 0.3 (P < 0.05). No significant side ef fects were observed. Tds modifies the autonomic balance in patients wi th severe CAD toward a condition associated with a better prognosis. I t may also be useful as an adjunctive treatment for ischemic heart dis ease.