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Articles in PresS, published online ahead of print November 27, 2002
Am J Physiol Regu Physiol, 10.1152/ajpregu.00287.2002
Submitted on May 21, 2002
Accepted on November 20, 2002
1 The Abramson Center for Medical Physics, Tel Aviv University, Tel Aviv, Israel
2 Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel
* To whom correspondence should be addressed. E-mail: solange{at}post.tau.ac.il.
Myocardial infarction (MI) is known to elicit activation of the autonomic nervous system. Reperfusion, induced by thrombolysis, is thus expected to bring about a shift in the balance between the sympathetic and vagal systems, according to the infarct location. In this study, we explored the correlation between reperfusion and the spectral components of heart rate variability (HRV), which are associated with autonomic cardiac control. We analyzed the HR of patients during thrombolysis; 9 anterior wall MI (AW-MI) and 8 inferoposterior wall MI (IW-MI). Reperfusion was determined from changes in ST levels and reported pain. Reocclusion was detected In 4 patients. HRV was analyzed using a modified continuous wavelet transform, which provided time-dependent versions of the typically used LF and HF peaks and of their ratio, LF/HF. Marked alterations in at least one of the HRV parameters was found in all 18 reperfusion events. Patterns of HRV, compatible with a shift toward relative sympathetic enhancement were found in all the 9 reperfusion events in IW-MI patients, and in 3 AW-MI patients. Patterns of HRV, compatible with relative vagal enhancement were found in 6 AW-MI patients (p<0.001). Significant changes in HRV parameters were also found after reocclusion. Time-dependent spectral analysis of HRV using the wavelet transform was found valuable for explaining the patterns of cardiac rate control during reperfusion. In addition, examination of the entire records revealed in two patients epochs of markedly diminished HRV, which we attribute to vagal saturation.
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