Autonomic effects of antiarrhythmic drugs and their importance

Lombardi, Federico; Torzillo, Daniela; Sandrone, Giulia; Vecchia, Laura Adelaide Dalla; Cappiello, E.

doi:10.1093/eurheartj/13.suppl_f.38

Cited by 16 publications

(6 citation statements)

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“…The effects of cardiovascular drugs on heart rate variability have been extensively studied. For Lombardi et al 36 amiodarone did not decrease heart rate variability indexes, unlike class I antiarrhythmic drugs. Severals authors have shown that angiotensin converting enzyme inhibitors and digoxin increase heart rate variability.37-39 However, no correlation was found in our work between heart rate variability indexes and these type of treatments.…”

Section: Discussionmentioning

confidence: 88%

Relationship Between Myocardial Beta‐Adrenergic Sensitivity and Heart Rate Variability

Cabrol

Galinier

Pathak

et al. 2000

Noninvasive Electrocardiol

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Background:In congestive heart failure, despite activation of the sympathetic nervous system, heart rate variability parameters reflecting sympathetic modulation on sinus node are decreased. Our goal was to assess the role of beta-adrenergic sensitivity in the modulation of heart rate variability (HRV) in patients with valvular heart diseases.Methods and results: Ten patients with aortic stenosis, 10 patients with heart failure, and 12 controls were included. Baroreflex sensitivity was calculated by the sequency method. Noradrenaline plasma levels were assayed by HPLC. HRV was studied using 24-hour Holter monitoring. Cardiac beta-adrenergic receptivity was assessed by the chronotropic response to dobutamine. Right auricular Sam les were obtained for determination of beta-adrenergic receptor density by binding between '251CP binding by isoprenaline. In multivariate analysis, the dose of dobutamine that increases basal heart rate for 25 beats/min (ED25) is correlated with a parameter of global HRV: SDNN (r = 0.6, P < 0.001) and with indexes reflecting rather sympathetic modulation of HRV: SDANN (r = 0.62, P < 0.001) or SD (r = 0.47, P < 0.0001). All these relations were independent from mean NN, spontaneous baroreflex sensitivity, and noradrenaline plasma levels. No significant correlation existed between dobutamine ED25 and HRV indexes reflecting parasympathic tone. No relationship existed between HRV and beta-adrenergic receptor-binding characteristics.Conclusion: Cardiac beta-adrenergic sensitivity explored by dobutamine ED25 is an important determinant of HRV independent from mean NN, spontaneous baroreflex sensitivity, and noradrenheart rate variabilitv; mvocardial beta-adrenerpic sensitivitv study with 1' P 51]-iodocynaopindoloI, and beta 1 and beta 2 densities, measured by competition aline plasma levels.

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Section: Discussionmentioning

confidence: 88%

Relationship Between Myocardial Beta‐Adrenergic Sensitivity and Heart Rate Variability

Cabrol

Galinier

Pathak

et al. 2000

Noninvasive Electrocardiol

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“…In 173 (78%) studies, safety is reported in total evaluating 7379 (82%) patients. 9 , 10 , 24 , 26 , 27 , 29–77 , 84–97 , 100 , 103–110 , 118 , 124–126 , 127 , 128–130 , 132 , 133 , 136–222 Survival is reported in 151 studies (68%). 9 , 10 , 25–32 , 35 , 40 , 43 , 46–50 , 52–63 , 66–71 , 73–80 , 84–87 , 89 , 91–98 , 100–113 , 119–126 , 128 , 130–139 , 142–145 , 148–159 , 161 , 162 , 164 , 165 , 169 , 171–173 , 175–177 , 181–184 , 188 , 190–194 , 196 , 199–201 , 204 , 207 , 208 , 211 , 212 , 214–217 , 220–229 …”

Section: Resultsmentioning

confidence: 99%

Effectiveness and safety of mexiletine in patients at risk for (recurrent) ventricular arrhythmias: a systematic review

et al. 2022

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While mexiletine has been used for over 40 years for prevention of (recurrent) ventricular arrhythmias and for myotonia, patient access has recently been critically endangered. Here we aim to demonstrate the effectiveness and safety of mexiletine in the treatment of patients with (recurrent) ventricular arrhythmias, emphasizing the absolute necessity of its accessibility. Studies were included in this systematic review (PROSPERO, CRD42020213434) if the efficacy or safety of mexiletine in any dose was evaluated in patients at risk for (recurrent) ventricular arrhythmias with or without comparison with alternative treatments (e.g. placebo). A systematic search was performed in Ovid MEDLINE, Embase, and in the clinical trial registry databases ClinicalTrials.gov and ICTRP. Risk of bias were assessed and tailored to the different study designs. Large heterogeneity in study designs and outcome measures prompted a narrative synthesis approach. In total, 221 studies were included reporting on 8970 patients treated with mexiletine. Age ranged from 0 to 88 years. A decrease in ventricular arrhythmias of >50% was observed in 72% of the studies for pre-mature ventricular complexes, 64% for ventricular tachycardia, and 33% for ventricular fibrillation. Electrocardiographic effects of mexiletine were small; only in a subset of patients with primary arrhythmia syndromes, a relative (desired) QTc decrease was reproducibly observed. As for adverse events, gastrointestinal complaints were most frequently observed (33% of the patients). In this systematic review, we present all the currently available knowledge of mexiletine in patients at risk for (recurrent) ventricular arrhythmias and show that mexiletine is both effective and safe.

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“…It has been shown that flecainide decreases heart rate variability. 11,12 The potential importance of the interaction between flecainide and activation of the sympathetic nervous system has also been suggested by the observation that the proarrhythmic effect of flecainide can be prevented by -blocking agents. [6][7][8] …”

Section: Anti-arrhythmic Drugs and Sympathetic Nerve Activitymentioning

confidence: 99%

“…Certain anti-arrhythmic drugs have been shown to influence muscle sympathetic nerve activity (MSNA) directly or via reflex mechanisms. 9,10 Although flecainide has been shown to produce a significant and marked reduction in heart rate variability, 11,12 there have been no studis of the direct effects of flecainide on MSNA in humans.…”

mentioning

confidence: 99%

Flecainide Augments Muscle Sympathetic Nerve Activity in Humans.

Nagata

2002

Circ J

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Autonomic effects of antiarrhythmic drugs and their importance

Cited by 16 publications

References 0 publications

Relationship Between Myocardial Beta‐Adrenergic Sensitivity and Heart Rate Variability

Relationship Between Myocardial Beta‐Adrenergic Sensitivity and Heart Rate Variability

Effectiveness and safety of mexiletine in patients at risk for (recurrent) ventricular arrhythmias: a systematic review

Flecainide Augments Muscle Sympathetic Nerve Activity in Humans.

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