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    The effect of glucose-insulin-potassium solution on ventricular late potentials and heart rate variability in acute myocardial infarction
    (Lippincott Williams & Wilkins, 2001) Ulgen, MS; Alan, S; Akdemir, O; Toprak, N
    Background Blunted heart rate variability (HRV) and presence of ventricular late potentials (VLPs) are known to correlate with an increased risk of ventricular tachycardia and sudden cardiac death in acute myocardial infarction (AMI), In the present study, we investigated the effect of glucose-insulin-potassium (GIK) solution on the VLPs and HRV in AMI. Methods Seventy-two consecutive patients with first Q wave AMI were randomized to GIK solution and placebo. HRV analysis and ambulatory electrocardiographic recordings were taken in all patients between 24 and 48 h. Sub-maximal 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 < 0.01) and frequency of VLPs (21 versus 45%; P < 0.05) were found to be significantly lower while root-mean-square voltage of the terminal 40 ms. of QRS (RMS-40: 45 +/- 18 versus 36 +/- 20 V; P < 0.05), and left ventricular ejection fraction (EF: 55 +/- 6 versus 48 +/- 7; P < 0.05) were significantly higher in the GIK group when compared to placebo. During the hospital period, the presence and frequency of post-myocardial infarction angina were significantly lower in the GIK group (15 versus 29%, P < 0.05), whereas an insignificant decrease in frequency of ventricular arrhythmias was observed in these patients. On HRV analysis, there was no significant difference between two groups in either time domain (SID, SDNN, RMS-SD) or frequency domain (HF, LF, LF/HF ratio) parameters. Conclusion GIK solution may be beneficial to VLPs, ischaemic events, and left ventricular systolic performance in the early period of AMI. This therapy has no significant effect on HRV in AM] patients. Coron Artery Dis 12:507-512 (C) 2001 Lippincott Williams &Lippincott Wilkins.
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    The effects of trimetazidine on heart rate variability and signal-averaged electrocardiography in early period of acute myocardial infarction
    (Elsevier Ireland Ltd, 2001) Ulgen, MS; Akdemir, O; Toprak, N
    Background: Acute myocardial infarction (AMI) is accompanied by electrophysiological changes in cardiovascular system as well as those in autonomic cardiac control. Heart rate variability (HRV) is depressed due to increased sympathetic activity and/or decreased parasympathetic activity following AMI. Moreover, the frequency of ventricular late potentials (VLP) is increased due to the electrophysiological changes. Based on the hypothesis that the treatments increasing HRV and decreasing the frequency of VLP can improve the prognosis of AMI, we investigated the short-term effects of trimetazidine (TMZ) on HRV and VLP in patients with AMI. Methods: The study group consisted of 64 patients (men 49, mean age 55 +/- 12 years, range 26-70) suffering from first Q-wave AMI. Thirty-one of them were treated with conventional therapy (thrombolytic therapy, aspirin, beta-blocker, heparin and intravenous nitroglycerin) plus TMZ 20 mg tid. The remaining 33 patients served as controls. Holter monitorization between 24 and 48 h, echocardiography at average day 6 (range 4-7 days) and SAECG and sub-maximal exercise at average day 7 (range 6-9 days) were performed to all patients. Results: While HRV parameters reflecting parasympathetic activity (SDSD: 43 +/- 16 ms-35 +/- 13 ms, RMSSD: 34 +/- 14 ms-27 +/- 8 ms, HF: 7.8 +/- 5 ms(2) -4.3 +/- 4 ms(2), P < 0.05) were of significantly higher levels in TMZ group, the low frequency component mainly reflecting sympathetic activity (LF: 10 6 ms(2)-10 +/- 5 ms(2), P > 0.05) was similar in both groups. In addition, LF/HF ratio showing sympatho-vagal balance was significantly decreased in TMZ group (1.5-3.0, P = 0.005). About VLP, the mean FQRS (105 +/- 8 ms-107 +/- 10 ms), LAS (28 +/- 10 ms-30 +/- 11 ms:) and RMS-40 (34 +/- 15 muV-41 +/- 12 muV) were not different in both two groups (P > 0.05). Conclusion: Our results suggest that TMZ treatment causes changes in sympatho-vagal balance in favor of vagal activity by increasing parasympathetic activity in AMI at early period; however, no effect on VLP was observed. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.