Objective To investigate the efficacy of Madopar on vascular parkinsonism with paroxysmal atrial fibrillation(VPD+ PAF)in elderly patients and its effect on the autonomic nervous system. Methods We recruited 50 patients aged over 60 with VPD + PAF into this randomized controlled trial.Based on sinus rhythm recorded by 24 hour ambulatory electrocardiogram ,individuals with an average heart rate below 60 times per minute were assigned into a sinus bradycardia group (n＝15)and those with a normal average heart rate were randomly assigned into a normal rate group (n＝20)or a control group (n＝ 15)by drawing lots.The control group was given routine care for 12 weeks ,while the other two groups were treated with Madopar plus routine care for 12 weeks. The three groups were examined using UPDRS-3 ,dynamic electrocardiogram ,heart rate variability , echocardiography ,and plasma acetylcholine(ACH)levels 1 day before treatment ,4 weeks and 12 weeks after treatment ,and atrial fibrillation frequency 2 weeks after treatment. Results UPDRS-3 scores decreased significantly in the sinus bradycardia group and the normal rate group after treatment for 4 weeks and 12 weeks ,compared with those before treatment (P＜0.05) ;UPDRS-3 scores in the control group did not show statistically significant changes at week 4 after treatment but decreased significantly at week 12(P＜0.05).UPDRS-3 scores in the sinus bradycardia group and the normal rate group were lower than those in the control group after treatment for 4 weeks and 12 weeks(P＜0.05). The total effectiveness rates in the sinus bradycardia group (86.7%,n＝13)and the normal rate group(85.0%,n＝17)were higher than the rate in the control group(53.3%,n＝8)(P＜0.05).Ach levels in the sinus bradycardia group and the normal rate group significantly decreased after treatment for 4 weeks and 12 weeks ,compared with before-treatment levels ,but no significant difference was observed between before-and after-treatment levels in the control group. Frequencies of AF in the sinus bradycardia group(5.6 ± 3.5)and the normal rate group(5.2 ± 4.1)were significantly lower than in the control group(8.4 ± 5.2)(P＜0.05). Conclusions Madopar can depress vagus nerve activity ,relieve VPD+ PAF symptoms ,and reduce the frequency of AF ;Heart rate variability and ACH level are potential predictors of clinical efficacy of Madopar in VPD patients.

Objective To explore the association between central vagus hyperfunction and paroxysmal atrial fibrillation(PAF).Methods The subjects were divided into 4 groups:i.e.the PAF group (50 cases),the cerebral infarction in basal ganglia with PAF group (or the CIBG-PAF group) (50 cases),the normal control group (50 cases),and the vascular Parkinson ＇s disease with PAF group (or the VP-PAF group) (30 cases).The subjects of the 4 groups all underwent heart rate variability and ultrasonic cardiography (UCG) detection and the level of acetylcholine ach (ACH) in plasma was determined by ELISA.Then,statistical analyses were made accordingly.Results (1) The levels of SDNN,RMSSD and HRV in the VP-PAF group were lower than those of the other 3 groups,and the levels of LF/HF were also lower than those of the other 3 groups.Statistical significance could be noted,when comparisons were made between the two(P ＜0.05).Statistical significance could also be noticed,when the CIBG-PAF group was compared with the PAF group and the control group(P ＜0.05).As compared with the control group,the levels of SDNN and SDANN in the PAF group were decreased and the levels of LF/HF were increased,and statistical significance could also be seen,when comparisons were made between them (P ＜ 0.05).(2) There was statistical difference in left ventricular ejection fraction (EF) and left atrium inner diameter in the subjects of the 4 groups (P ＜ 0.05).(3) The level of ACH in the patients of the VP-PAF group [(814 ± 301) ng/L] was higher than those of the other 3 groups [CIBG-PAF group:(673 ±218) ng/L;PAF group:(534±195) ng/L;Control group:(313 ± 112) ng/L] (P ＜ 0.05),and statistical significance could be seen when comparisons were made between them (P ＜ 0.05).The level of ACH in the CIBG-PAF group was higher than those of the PAF group and control group,and statistical significance could be found when comparisons were nade between them (P ＜ 0.05).However,statistical significance was not shown when comparisons were made between the PAF group and the control group (P ＜ 0.05).In the PAF group,close association was noticed in the levels of SDNN,SDANN,RMSSD,PNN50 as well as ACH in the plasma,also with statistical significance (P ＜ 0.05).Conclusions Cerebral infarction in basal ganglia could induce hyperfunction of exogenous central vagus nerve and was also one of the direct causes of PAF.

Objective To explore the association between central vagus hyperfunction and paroxysmal atrial fibrillation(PAF).Methods The subjects were divided into 4 groups:i.e.the PAF group (50 cases),the cerebral infarction in basal ganglia with PAF group (or the CIBG-PAF group) (50 cases),the normal control group (50 cases),and the vascular Parkinson ＇s disease with PAF group (or the VP-PAF group) (30 cases).The subjects of the 4 groups all underwent heart rate variability and ultrasonic cardiography (UCG) detection and the level of acetylcholine ach (ACH) in plasma was determined by ELISA.Then,statistical analyses were made accordingly.Results (1) The levels of SDNN,RMSSD and HRV in the VP-PAF group were lower than those of the other 3 groups,and the levels of LF/HF were also lower than those of the other 3 groups.Statistical significance could be noted,when comparisons were made between the two(P ＜0.05).Statistical significance could also be noticed,when the CIBG-PAF group was compared with the PAF group and the control group(P ＜0.05).As compared with the control group,the levels of SDNN and SDANN in the PAF group were decreased and the levels of LF/HF were increased,and statistical significance could also be seen,when comparisons were made between them (P ＜ 0.05).(2) There was statistical difference in left ventricular ejection fraction (EF) and left atrium inner diameter in the subjects of the 4 groups (P ＜ 0.05).(3) The level of ACH in the patients of the VP-PAF group [(814 ± 301) ng/L] was higher than those of the other 3 groups [CIBG-PAF group:(673 ±218) ng/L;PAF group:(534±195) ng/L;Control group:(313 ± 112) ng/L] (P ＜ 0.05),and statistical significance could be seen when comparisons were made between them (P ＜ 0.05).The level of ACH in the CIBG-PAF group was higher than those of the PAF group and control group,and statistical significance could be found when comparisons were nade between them (P ＜ 0.05).However,statistical significance was not shown when comparisons were made between the PAF group and the control group (P ＜ 0.05).In the PAF group,close association was noticed in the levels of SDNN,SDANN,RMSSD,PNN50 as well as ACH in the plasma,also with statistical significance (P ＜ 0.05).Conclusions Cerebral infarction in basal ganglia could induce hyperfunction of exogenous central vagus nerve and was also one of the direct causes of PAF.