The effect of glucose-insulin-potassium solution on ventricular late potentials and heart rate variability in acute myocardial infarction

Background Blunted heart rate variability (HRV) and presence of ventricular late potentials (VLPs) are known to correlate with an increased risk of ve ntricular tachycardia and sudden cardiac death in acute myocardial infarcti on (AMI), In the present study, we investigated the effect of glucose-insul in-potassium (GIK) solution on the VLPs and HRV in AMI. Methods Seventy-two consecutive patients with first Q wave AMI were randomi zed to GIK solution and placebo. HRV analysis and ambulatory electrocardiog raphic recordings were taken in all patients between 24 and 48 h. Sub-maxim al exercise testing and echocardiography were performed and signal-averaged electrocardiography (SAECG) was recorded before discharge. Results Total filtered QRS duration (FORS: 102 +/- 7 versus 108 +/- 11 ms; P < 0.05), low-amplitude signal (LAS: 25 +/- 8 versus 32 +/- 11 ms; P < 0.0 1) and frequency of VLPs (21 versus 45%; P < 0.05) were found to be signifi cantly lower while root-mean-square voltage of the terminal 40 ms. of QRS ( RMS-40: 45 +/- 18 versus 36 +/- 20 <mu>V; P < 0.05), and left ventricular e jection fraction (EF: 55 +/- 6 versus 48 +/- 7; P < 0.05) were significantl y higher in the GIK group when compared to placebo. During the hospital per iod, the presence and frequency of post-myocardial infarction angina were s ignificantly lower in the GIK group (15 versus 29%, P < 0.05), whereas an i nsignificant decrease in frequency of ventricular arrhythmias was observed in these patients. On HRV analysis, there was no significant difference bet ween two groups in either time domain (SID, SDNN, RMS-SD) or frequency doma in (HF, LF, LF/HF ratio) parameters. Conclusion GIK solution may be beneficial to VLPs, ischaemic events, and le ft ventricular systolic performance in the early period of AMI. This therap y has no significant effect on HRV in AM] patients. Coron Artery Dis 12:507 -512 (C) 2001 Lippincott Williams &Lippincott Wilkins.