• A S Androne, K Hryniewicz, R Goldsmith, A Arwady, and S D Katz.
• Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
• Heart. 2003 Aug 1; 89 (8): 854-8.

ObjectiveTo characterise the effects of acetylcholinesterase inhibition with pyridostigmine on parasympathetic tone in patients with chronic heart failure (CHF).DesignProspective randomised, double blind crossover trial.SettingUniversity hospital outpatient heart failure clinic.Patients20 ambulatory subjects with stable CHF (mean age 55 years, mean ejection fraction 24%).InterventionsOral administration of a single dose of pyridostigmine 30 mg and matching placebo on separate days.Main Outcome MeasuresHeart rate recovery at one minute and three minutes after completion of maximal exercise.ResultsHeart rate recovery at one minute after exercise was significantly greater after administration of pyridostigmine than after administration of placebo (mean (SEM) 27.4 (3.2) beats/min v 22.4 (2.4) beats/min, p < 0.01). Heart rate recovery at three minutes after exercise did not differ after administration of pyridostigmine and placebo (mean (SEM) 44.4 (3.9) beats/min v 41.8 (3.6) beats/min, NS). Peak heart rate, peak oxygen uptake, peak respiratory exchange ratio, plasma noradrenaline (norepinephrine) concentrations, and plasma brain natriuretic peptide concentrations did not differ after administration of pyridostigmine and placebo.ConclusionsAcetylcholinesterase inhibition with pyridostigmine increased heart rate recovery at one minute but not at three minutes after exercise. A specific effect of pyridostigmine on heart rate one minute after exercise suggests that pyridostigmine augments parasympathetic tone in patients with CHF.

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