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Brain & Heart Atropine can reducing reperfusion vagal reflex in STEMI

the heart rate in some patients , without changes in blood 5. Conclusion
[3]
pressure or cardiac output. The mechanism by which
atropine slows the heart rate is by blocking the negative- Prophylactic intracoronary atropine could significantly
feedback inhibition of parasympathetic postganglionic reduce the risk of reperfusion vagal reflex-related events
fibers. High doses of atropine (2 mg) can block nerve during emergency PCI for acute inferior STEMI and
receptors and remove the inhibitory effect of the vagus improve the safety of this procedure. These effects can
nerve on the heart, leading to an increased heart rate . be significantly enhanced by high-dose (2 mg) atropine
[18]
In this study, high-dose atropine had greater advantage in pretreatment.
inhibiting the reperfusion response than low-dose atropine Acknowledgments
and significantly reduced the incidence of reperfusion
arrhythmia. In the low-dose atropine preconditioning None.
group, mild bradycardia and hypotension still occurred
in some patients during reperfusion, with the majority of Funding
them requiring a full dose of atropine. In addition, the use None.
of atropine before reperfusion can reduce the incidence
of ventricular fibrillation. Ventricular fibrillation did not Conflict of interest
occur in any of the patients in the high-dose atropine group. The authors declare no conflicts of interest.
The use of atropine significantly reduced the occurrence
of ventricular arrhythmias, while correcting bradycardia Author contributions
and hypotension. These findings further strengthen the
evidence that atropine has significant therapeutic value in Conceptualization: Lingping Xu
patients with acute inferior STEMI. Data curation: Yichao Duan, Chuanmin Fan, Bo Zhang
Investigation: Jing Wang, Chuanmin Fan, Bo Zhang
However, it has been reported that prophylactic Methodology: Junlong Hou, Erqing Li
atropine may cause severe ventricular fibrillation after Writing – original draft: Yichao Duan, Bin Chen, Liming
ameliorating bradycardia, but the exact mechanism Qin
responsible for the induction of ventricular irritability Writing – review & editing: Lingping Xu
after atropine administration is not entirely clear. The
increase in myocardial oxygen demand brought about by Ethics approval and consent to participate
the increased heart rate appears to be the most important This study was approved by the Ethical Committee of
factor, and it may be akin to that of ventricular irritability Xianyang Central Hospital (Approval No. 20200059), and
that occasionally occurs during atrial pacing or exercise informed consent was obtained from the patients and their
in patients with ischemic heart disease [19,20] . Moreover, families.
the egress of potassium from myocardial cells, which is
associated with tachycardia, may play an important role Consent for publication
in promoting ventricular irritability. Atropine can lower
the threshold of ventricular fibrillation and increase Informed consent was obtained from the patients and their
the disparity of refractory periods during ischemia . families.
[21]
However, in this study, the apparent provocation of Availability of data
ventricular arrhythmias by atropine was not observed.
Hence, we conclude that atropine may be beneficial in Data can be obtained from the corresponding author
certain circumstances for preventing reperfusion vagal following request.
reflex-related events in acute myocardial infarction .
[22]
We acknowledge certain limitations of our work. First, References
given the retrospective nature of this study, we were unable 1. Webb SW, Adgey AA, Pantridge JF, 1972, Autonomic
to gather clinical information on every prognostic factor disturbance at onset of acute myocardial infarction. Br Med
in the cohort despite our extensive exploration of the J, 3: 89–92.
clinical data. Second, this was a single-center retrospective 2. Thames MD, Klopfenstein H, Abboud F, et al., 1978,
study with a small sample size. Third, the discrepancies in Preferential distribution of inhibitory cardiac receptors with
the dose and duration of atropine administration due to vagal afferents to the inferoposterior wall of the left ventricle
differing experiences or skills among clinicians as well as activated during coronary occlusion in the dog. Circ Res,
the resulting differences in the potential of atropine to act 43: 512–519.
may lead to biases. https://doi.org/10.1161/01.res.43.4.512

Volume 1 Issue 1 (2023) 6 https://doi.org/10.36922/bh.193