Summary
The effects of the autonomic nervous system on malignant arrhythmias, particularly in the setting of ischemic heart disease, have been widely investigated and described. Specifically, it has been shown that while sympathetic hyperactivity is arrhythmogenic, an increased vagai activity often exerts a beneficial effect. New insights on the relationship between autonomie activity and sudden cardiac death have been obtained in conscious dogs in which a healed myocardial infarction, acute myocardial ischemia, and exercise are combined. In this chronic animal model it was shown that myocardial infarction reduces baroreflex sensitivity and heart rate variability (markers of vagai reflex and tonic activity to the heart) and that a depressed baroreflex sensitivity or a reduced heart rate variability after myocardial infarction indicate an increased risk for ventricular fibrillation. The validity of these experimental observations was confirmed in clinical studies in patients with a myocardial infarction. The protective effect of vagai activity was further confirmed in two experimental studies in which muscarinic stimulation, both electrically and pharmacologically induced, was able to prevent ventricular fibrillation during acute myocardial ischemia. These observations have led to new research directions. At the experimental level, the effect of Gi proteins activity blockade by pertussis toxin on the cardiac response to vagai activation is currently evaluated in conscious dogs. At the clinical level, the prognostic value after myocardial infarction of baroreflex sensitivity and of heart rate variability will be tested in a large, multicenter, prospective study.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Berger RD, Akselrod S, Gordon D, Cohen RJ (1986) An efficient algorithm for spectral analysis of heart rate variability. IEEE Trans Biomed Eng 9, 900–904
Bigger JT Jr, Kleiger RE, Fleiss JL, Rolnitzky LM, Steinman RC, Miller JP and The Multicenter Post-Infarction Research Group (1988) Components of heart rate variability measured during healing of acute myocardial infarction. Am J Cardiol 61, 208–215
Bigger JT Jr., La Rovere MT, Steinman RC, Fleiss JL, Rottman JN, Rolnitzky LM, Schwartz PJ (1989) Comparison of baroreflex sensitivity and heart period variability after myocardial infarction. J Am Coll Cardiol 14, 1511–1518
Billman GE, Schwartz PJ, Stone HL (1982) Baroreceptor reflex control of heart rate: A predictor of sudden cardiac death. Circulation 66, 874–880
Billman GE, Schwartz PJ, Stone HL (1984) The effects of daily exercise on susceptibility to sudden cardiac death. Circulation 69, 1182–1189
Billman GE, Schwartz PJ, Gagnol JP, Stone HL (1985) The cardiac response to submaximal exercise in dogs susceptible to sudden cardiac death. J Appl Physiol 59, 890–897
Brown AM, Birnbaumer L (1988) Direct G protein gating of ion channels. Am J Physiol 254:H401–H410
Cerati D, Schwartz PJ (1989) Vagai reflexes and survival during acute myocardial ischemia in cats. Circulation 80(Suppl II):522 (abstr.)
Cohen J (1969) Statistical power analysis for behavioral sciences. New York, Academic Press 89
Corr PB, Yamada KA, Witkowski FX (1986) Mechanisms controlling cardiac autonomic function and their relation to arrhythmogenesis. In: Fozzard HA, Haber E, Jennings RB, Katz AM, Morgan HE (Eds.) The Heart and Cardiovascular System. Vol. II, Raven Press, New York, pp 1343–1403
De Ferrari GM, Vanoli E, Stramba-Badiale M, Foreman RD, Schwartz PJ (1987) Vagai stimulation and sudden death in conscious dogs with a healed myocardial infarction. Circulation 76(suppl IV): 107 (abstr.)
De Ferrari GM, Vanoli E, Tommasini G, Grossoni M, Uckmar G, Patrono C, Schwartz PJ (1989) Antiarrhythmic effect of muscarinic agonists during acute myocardial ischemia. Circulation 80(Suppl IV):202 (abstr.)
Eckberg DL (1983) Human sinus arrhythmia as an index of vagai cardiac outflow. J Appl Physiol 54, 961–966
Ewing DJ, Neilson JMM, Travis P (1984) New method for assessing cardiac parasympathetic activity using 24-hour electrocardiograms. Br Heart J 52, 396–402
Fleming JW, Watanabe AM (1986) Biochemical mechanisms of parasympathetic regulation of cardiac function. In: Fozzard HA, Haber E, Jennings RB, Katz AM, Morgan HE (Eds.) The Heart and Cardiovascular System, Raven Press, New York, pp 1679–1688
Fleming JW, Hodges TD, Watanabe AM (1988) Pertussis toxin-treated dog: A whole animal model of impaired inhibitory regulation of adenylate cyclase. Circ Res 62, 992–1000
Gilman AG (1984) G proteins and dual control of adenylate cyclase. Cell 36, 577–579
Gnecchi Ruscone T, Lombardi F, Malfatto G, Malliani A (1987) Attenuation of baroreceptive mechanisms by cardiovascular sympathetic afferent fibers. Am J Physiol 253:H787–H791
Hull SS, Vanoli E, Adamson PB, Green FJ, De Ferrari GM, Foreman RD, Schwartz PJ, Watanabe AM (1989) Pertussis toxin alters vagai control of heart rate in conscious dogs. Circulation 80(Suppl II): 12 (abstr.)
Hull SS, Evans A, Vanoli E, Adamson PB, Albert DE, Foreman RD, Stramba-Badiale M, Schwartz PJ (1990) Heart rate variability before and after myocardial infarction in conscious dogs at high and low risk of sudden death. J Am Coll Cardiol 16, 978–985
Katona PG, Jih F (1975) Respiratory sinus arrhythmia: Noninvasive measure of parasympathetic cardiac control. J Appl Physiol 39, 801–805
Kay SM, Marple SL (1981) Spectrum analysis: A modern perspective. Proc IEEE 69, 1380–1419
Kent KM, Smith ER, Redwood DR, Epstein SE (1973) Electrical stability of acutely ischemic myocardium: Influence of heart rate and vagai stimulation. Circulation 47, 291–298
Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ, and The Multicenter Post-Infarction Research Group (1987) Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 59, 256–262
Kunze DL (1972) Reflex discharge patterns of cardiac vagai efferent fibres. J Physiol 222, 1–15
La Rovere MT, Specchia G, Mortara A, Schwartz PJ (1988) Baroreflex sensitivity, clinical correlates and cardiovascular mortality among patients with a first myocardial infarction: A prospective study. Circulation 78, 816–824
Lombardi F, Sandrone G, Pernpruner S, Sala R, Garimoldi M, Cerutti S, Baselli G, Pagani M, Malliani A (1987) Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction. Am J Cardiol 60, 1239–1245
Lown B (1979) Sudden cardiac death: The major challenge confronting contemporary cardiology. Am J Cardiol 43, 313–320
Mancia G, Mark AL (1983) Arterial baroreflexes in humans. In: Shephard JL, Abboud FM (Eds.) Handbook of Physiology: The Cardiovascular System, Vol. III. Bethesda, Md, Am Physiol Soc, pp 755–793
Myers GA, Martin GJ, Magid NM, Barnett PS, Schaad JW, Weiss JS, Lesch M, Singer DH (1986) Power spectral analysis of heart rate variability in sudden cardiac death: Comparison to other methods. IEEE Trans Biomed Eng 33, 1149–1156
Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, Sandrone G, Malfatto G, Dell’Orto S, Piccaluga E, Turiel M, Basselli G, Cerutti S, Malliani A (1986) Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 59, 178–193
Pomeranz B, Macaulay RJB, Caudill MA, Kutz I, Adam D, Gordon D, Kilborn KM, Barger AC, Shannon DC, Cohen RJ, Benson H (1985) Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol 248:H151–H153
Priori SG, Zuanetti G, Schwartz PJ (1988) Ventricular fibrillation induced by the interaction between acute myocardial ischemia and sympathetic hyperactivity: Effect of nifedipine. Am Heart J 116, 37–43
Rich MW, Saini JS, Kleiger RE, Carney RM, teVelde A, Freedland KE (1988) Correlation of heart rate variability with clinical and angiographic variables and late mortality after coronary angiography. Am J Cardiol 62, 714–717
Rothschild M, Rothschild A, Pfeifer M (1988) Temporary decrease in cardiac parasympathetic tone after acute myocardial infarction. Am J Cardiol 62, 637–639
Scheuer J, Tipton CM (1979) Cardiovascular adaptation to physical training. Ann Rev Physiol 39, 221–251
Schwartz PJ, Pagani M, Lombardi F, Malliani A, Brown AM (1973) A cardiocardiac sympatho-vagal reflex in the cat. Circ Res 32, 215–220
Schwartz PJ, Stone HL, Brown AM (1976) Effects of unilateral stellate ganglion blockade on the arrhythmias associated with coronary occlusion. Am Heart J 92, 589–599
Schwartz PJ, Brown AM, Malliani A, Zanchetti A (Eds.) (1978) Neural Mechanisms in Cardiac Arrhythmias. Raven Press, New York
Schwartz PJ, Vanoli E (1981) Cardiac arrhythmias elicited by interaction between acute myocardial ischemia and sympathetic hyperactivity: a new experimental model for the study of antiarrhythmic drugs. J Cardiovasc Pharmacol 3, 1251–1259
Schwartz PJ, Billman GE, Stone HL (1984) Autonomie mechanisms in ventricular fibrillation induced by myocardial ischemia during exercise in dogs with a healed myocardial infarction. An experimental preparation for sudden cardiac death. Circulation 69, 780–790
Schwartz PJ, Stone HL (1985) The analysis and modulation of autonomie reflexes in the prediction and prevention of sudden death. In: Zipes DP, Jalife J (Eds.) Cardiac Arrhythmias: Mechanisms and Management, Grune and Stratton, New York, pp 165–176
Schwartz PJ, Vanoli E, Zaza A, Zuanetti G (1985) The effect of antiarrhythmic drugs on life-threatening arrhythmias induced by the interaction between acute myocardial ischemia and sympathetic hyperactivity. Am Heart J 109, 937–948
Schwartz PJ, Priori SG, Vanoli E, Zaza A, Zuanetti G (1986) Efficacy of diltiazem in two experimental feline models of sudden cardiac death. J Am Coll Cardiol 8, 661–668
Schwartz PJ, Stramba-Badiale M (1988) Parasympathetic nervous system and cardiac arrhythmias. In: Kulbertus HE, Frank G (Eds.), Neurocardiology, Futura Publishing Co., Mount Kisco, NY, pp 179–200
Schwartz PJ, Vanoli E, Stramba-Badiale M, De Ferrari GM, Billman GE, Foreman RD (1988) Autonomie mechanisms and sudden death. New insight from the analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. Circulation 78, 969–973
Schwartz PJ, Zaza A, Pala M, Locati E, Beria G, Zanchetti A (1988) Baroreflex sensitivity and its evolution during the first year after a myocardial infarction. J Am Coll Cardiol 12, 629–636
Schwartz PJ, Priori SG (1990) Sympathetic nervous system and sudden death. In: Zipes DP, Jalife J (Eds.) Cardiac Electrophysiology. From Cell to Bedside, WB Saunders Co, Philadelphia, (In press)
Singer DH, Martin GJ, Magid N, Weiss JS, Schaad JW, Kehoe R, Zheutlin T, Fintel DJ, Hsieh AM, Lesch M (1988) Low heart rate variability and sudden cardiac death. J Electrocardiol Suppl: S46-S65
Smyth HS, Sleight P, Pickering GW (1969) Reflex regulation of arterial pressure during sleep in man. Circ Res 24, 109–121
Stone HL (1977) Cardiac function and exercise training in conscious dogs. J Appl Physiol 42, 824–832
Stramba-Badiale M, De Ferrari GM, Vanoli E, Billman GE, Hull SS, Foreman RD, Schwartz PJ (1988) Myocardial ischemia and ventricular fibrillation in conscious dogs. Atropine and the role of vagai reflex. Fed Proc 47:A327 (abstr.)
Verrier RL (1980) Neural factors and ventricular electrical instability. In: Kulbertus HE, Wellens HJJ (Eds.) Sudden Death, Martinus Nijhoff, The Hague, pp 137–155
Author information
Authors and Affiliations
Editor information
Rights and permissions
Copyright information
© 1991 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Vanoli, E., Schwartz, P.J. (1991). Sympathetic — Parasympathetic Interaction and Sudden Death. In: Heusch, G., Ross, J. (eds) Adrenergic Mechanisms in Myocardial Ischemia. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-662-11038-6_25
Download citation
DOI: https://doi.org/10.1007/978-3-662-11038-6_25
Publisher Name: Steinkopff, Heidelberg
Print ISBN: 978-3-662-11040-9
Online ISBN: 978-3-662-11038-6
eBook Packages: Springer Book Archive