Low dose transdermal scopolamine increases cardiac vagal tone in patients after acute myocardial infarction

Objective To investigate whether transdermal scopolamine increased cardiac vagal activity in patients during the acute phase of myocardial infarction. Methods 30 patients with a first acute myocardial infarction and preserved sinus rhythm who were on no drug that could influence the sinus node were randomly assigned to either treatment group or placebo group. Measures of heart rate variability (HRV) in patients given drug or placebo were obtained by digital 24 hour Holter recording before and after treatment. Baroreflex sensitivity was performed using the phenylephrine method. Results No significant differences was found in the indices of the time domain and the frequency domain in both groups before treatment. Patients with transdermal scopolamine showed a significant increase in the standard deviation of normal RR intervals (SDNN), standard deviation of all five min mean normal RR intervals (SDANN), root mean square of differences of successive normal RR intervals (rMSSD), total power (TP, 0.00-0.40 Hz), low frequency peak (LF, 0.04-0.15 Hz), high frequency peak (HF, 0.15-0.40 Hz), and Baroreflex sensitivity after treatment ( P < 0.05-0.01). These indices did not change in patients given placebo. Conclusion Low doses of transdermal scopolamine safely increase cardiac parasympathetic activity and improve autonomic indices in patients with acute myocardial infarction.