Acute and long-term effects of fingolimod on heart rhythm and heart rate variability in patients with multiple sclerosis

The treatment with fingolimod leads to an increase of vagal activation which persists even after 14 months of treatment. These changes did not return to baseline levels on treatment with fingolimod. Based on our data an additional at least 24 h hour-HEM after the initiation of fingolimod therapy should be considered.