H2-Blocker modulates heart rate variability

Ooie, Tatsuhiko; Saikawa, Tetsunori; Hara, Masahide; Ono, Hidenobu; Seike, Masataka; Sakata, Toshiie

doi:10.1007/bf02482297

Cited by 13 publications

(6 citation statements)

References 23 publications

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“…This finding was unexpected; prior observational studies have not reported similar findings 7,8. Although this may represent a type 1 (false finding of difference) error, a potential explanation for a real effect could be a known side effect of ranitidine in adults: arrhythmias (tachycardia, bradycardia, atrioventricular block, premature ventricular beats) 15,16…”

Section: Discussionmentioning

confidence: 99%

Cross-Over Trial of Treatment for Bradycardia Attributed to Gastroesophageal Reflux in Preterm Infants

Wheatley

Kennedy

2009

The Journal of Pediatrics

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Objective-To determine whether anti-reflux medications reduce bradycardia episodes attributed to clinically suspected gastroesophageal reflux (GER).Study design-We conducted a masked trial comparing metoclopramide, 0.2 mg/kg/dose q 6 hours, and ranitidine, 2 mg/kg/dose q 8 hours, with saline placebo. Each infant served as his own control. Preterm infants having >3 bradycardia episodes per 2 days were eligible if the clinician intended to begin anti-reflux medications for bradycardia attributed to GER.Results-The mean (SD) birth weight was 1238 (394) g and gestational age was 29 (3) weeks. Eighteen infants were enrolled at 35 (22) days of age. There were 4.6 (3.1) and 3.6 (2.7) bradycardia episodes per day in the drug and placebo periods, respectively. The mean difference (drug minus placebo) was 0.94 (95% CI, 0.04 to 1.95) (P = .04 by t test). There was a decrease in bradycardia episodes over time (P < .001 by nonparametric repeated-measures analysis of variance).Conclusions-Anti-reflux medications did not reduce, and may have increased, bradycardia episodes in preterm infants with GER. Because there was an improvement of bradycardia episodes over time, unrelated to treatment, unmasked therapeutic trials of medications are likely to lead to misleading conclusions.Gastroesophageal reflux (GER), commonly defined as the involuntary passage of gastric contents into the esophagus, has been reported to occur in more than 85% of preterm infants. 1 In some infants, GER can be severe enough to cause gastroesophageal reflux disease (GERD), which results in malnutrition, esophagitis, or respiratory disease. 2 Claims have been made since the 1970s that apnea in preterm infants could be caused by GER. 3,4 Apnea and bradycardia are very common in preterm infants; episodes frequently occur during and after feeding when GER is also frequent. 5 Apnea and bradycardia occurring around feedings might be causally related to GER by the mechanism of refluxate traveling up the esophagus, blocking the airway, and causing an obstructive apnea and subsequent bradycardia. Another proposed mechanism to link these events is the laryngeal chemoreflex, which causes respiratory pauses and airway closure immediately after regurgitation to the upper airway. 6 However, numerous observational studies have failed to demonstrate a temporal relationship between GER events and apnea. 7 Common diagnostic approaches to GER include the upper gastrointestinal series (UGI) and the pH probe study. The UGI, which consists of radiographs taken after contrast material is infused or swallowed into the stomach, is neither sensitive nor specific for the diagnosis of GER. 8 The pH probe study, which is the traditional gold standard for diagnosing GERD,The authors declare no potential conflicts of interest, real or perceived. There have been no prospective randomized trials of treatment for GERD in preterm infants with or without apnea and bradycardia. The purpose of our study was to determine whether anti-reflux medications reduce bradycardia attributed to ...

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Section: Discussionmentioning

confidence: 99%

Cross-Over Trial of Treatment for Bradycardia Attributed to Gastroesophageal Reflux in Preterm Infants

Wheatley

Kennedy

2009

The Journal of Pediatrics

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“…Therefore, changes in autonomic nervous activity and/or sympathovagal balance may be involved in the cardiovascular effects. Further, cardiovascular effects of H2-blocker may be related to the autonomic nervous system, and modulated activity, and/or sympathovagal balance [5].…”

Section: Discussionmentioning

confidence: 99%

“…In a previous report, the use of high-dose H2blocker was associated with several adverse effects such as bradycardia, sinus arrest, atrio-ventricular conduction disturbances, and cardiac decompensation [4]. However, another study reported that H2-blocker could modulate heart-rate variability, and has the possibility to inhibit the increase in the sinus rate and prevent ventricular ectopy [5].…”

Section: Introductionmentioning

confidence: 99%

Can negative cardiac effect of proton pump inhibitor and high-dose H2-blocker have clinical influence on patients with stable angina?

Tanaka

Nishigaki

Ojio

et al. 2008

Journal of Cardiology

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“…[105,106] Omeprazole use has been shown to be well tolerated in adults for ≥10 years and in children for over 2 years. [107,108] While antireflux surgery in certain groups of children may be of considerable benefit, it also has a certain mortality and a failure rate of several percentage points.…”

Section: What If Cisapride Is No Longer Available?mentioning

confidence: 99%

Efficacy and Tolerability of Cisapride in Children

Vandenplas¹,

Benatar²,

Cools³

et al. 2001

Paediatric Drugs

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As gastro-oesophageal reflux disease (GORD) in infants and children is a motility disorder which differs in pathophysiology and clinical course from GORD in adults, prokinetics should be considered the drug of choice in certain circumstances. Indeed, cisapride may result in improvement of feeding tolerance in premature infants. Cisapride has a better tolerability profile than a 'wait-and-see-if-improvement-comes-spontaneously' policy or the other therapeutic options available. A careful and critical review of published data suggests that cisapride may have a QTc-prolonging effect. However, provided the precautions for cisapride administration are followed, the QTc-prolonging effect remains consistently without clinically relevant adverse effects. Correct dosage and avoidance of concurrent treatment with macrolides and/or azoles are the most relevant tolerability recommendations in children. Although there is a need for a prokinetic with better efficacy, cisapride is currently the prokinetic with the best benefit-to-risk ratio available. Thus, withdrawal of cisapride would result in a significantly increased risk for severe complications in infants and children with GORD or other gastrointestinal motility disorders such as chronic intestinal pseudo-obstruction, gastroparesis and feed intolerance in premature infants.

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H2-Blocker modulates heart rate variability

Cited by 13 publications

References 23 publications

Cross-Over Trial of Treatment for Bradycardia Attributed to Gastroesophageal Reflux in Preterm Infants

Cross-Over Trial of Treatment for Bradycardia Attributed to Gastroesophageal Reflux in Preterm Infants

Can negative cardiac effect of proton pump inhibitor and high-dose H2-blocker have clinical influence on patients with stable angina?

Efficacy and Tolerability of Cisapride in Children

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