digitoxin and Atrial-Fibrillation

Publishe d decades after several randomized controlled trials (RCT) demonstrating decreased hospitalizations and no effect on all-cause mortality with digoxin use, a series of meta-analyses linking digoxin treatment and mortality have contributed to a narrower application of this medication for the management of heart failure (HF) and atrial fibrillation (AF). Given the conflicting data from the earlier RCTs and more recent meta-analyses, there is a growing polarization among providers for and against the use of digoxin in managing these conditions.. To help close this divide, we provide a perspective on the literature with special attention to the quality of both older and more recent studies on this subject.. The data from the highest quality studies we have, RCTs, suggest that digoxin use in patients with HF and/or AF is associated with improvement in several areas of outcomes including functional capacity, symptom management, reduced hospitalizations, fewer deaths due to HF, and treatment of refractory chronic heart failure with rEF, and may even have overall mortality benefit when serum digoxin concentrations are within therapeutic range. These effects are more pronounced in patients with EF < 25% and NYHA Class II-IV and at highest risk for hospitalization.. As the risk of confounding factors was minimized by the study design, the likelihood that positive outcomes were identified with digoxin use increased. Clinicians and researchers need further adequately designed and powered RCTs exploring the connection between digoxin therapy and mortality, hospitalizations, and symptom management.

Topics: Atrial Fibrillation; Digitalis; Digoxin; Heart Failure; Humans; Randomized Controlled Trials as Topic

Heart failure (HF) is a medical condition inability of the heart to pump sufficient blood to meet the metabolic demand of the body to take place. The number of hospitalized patients with cardiovascular diseases is estimated to be more than 1 million each year, of which 80% to 90% of patients ultimately progress to decompensated HF. Digitalis glycosides exert modest inotropic actions when administered to patients with decompensated HF. Although its efficacy in patients with HF and atrial fibrillation is clear, its value in patients with HF and sinus rhythm has often been questioned. A series of recent studies have cast serious doubt on the benefit of digoxin when added to contemporary HF treatment. We are hypothesizing the role and mechanism of exosome and its biological constituents responsible for worsening the disease state and mortality in decompensated HF patients on digitalis.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiotonic Agents; Digitalis; Digoxin; Exosomes; Heart Failure; Humans; Plant Extracts; Wnt Signaling Pathway

Digoxin is one of the oldest of drugs acting on the heart and still one of the most frequently used. While in atrial fibrillation digoxin continues to have a valid role in the control of ventricular rate when added to beta-blockers and calcium antagonists, digoxin for heart failure is no longer a supportable option in view of the negative recent meta-analysis.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Digitalis; Digoxin; Heart Failure; Humans; Plant Preparations

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Atrial Fibrillation; Catheter Ablation; Clinical Trials as Topic; Diagnosis, Differential; Digitalis; Humans; Pacemaker, Artificial; Thromboembolism; Warfarin

One day after drinking what she thought to be a tea made from borage leaves a 72-year-old woman developed nausea, vomiting and diarrhoea, later also flickering in her eyes and palpitations. She was in a good general state with a blood pressure of 120/75 mm Hg and an irregular heart rate of 52/min. Physical examination was otherwise unremarkable. She had not been on any medication.. The usual laboratory tests were normal. The electrocardiogram showed atrial fibrillation with a slow ventricular rate with pauses of up to 1.5s. intermittently type I and II 2 degrees AV block, and depressed concave ST segments. The level of digoxin was 3.93 ng/ml, that of digitoxin 133.5 ng/ml.. The patient's symptoms quickly improved under symptomatic treatment. Further questioning suggested that she had probably mistaken foxglove leaves for those of borage when picking them to make a brew.. If cardiac arrhythmias have occurred after intake of self-picked herbal leaves one should consider digitalis intoxication resulting from misidentification.

Topics: Acute Disease; Aged; Atrial Fibrillation; Bradycardia; Diarrhea; Digitalis; Female; Humans; Plant Poisoning; Plants, Medicinal; Plants, Toxic; Tea; Vomiting

Topics: Adrenergic beta-Antagonists; Aged; Aging; Atrial Fibrillation; Cardiovascular Physiological Phenomena; Digitalis; Diuretics; Dose-Response Relationship, Drug; Endocarditis, Bacterial; Heart; Heart Block; Heart Diseases; Humans; Hypertension; Mitral Valve; Plants, Medicinal; Plants, Toxic; Potassium Deficiency; Risk

The pharmacokinetics of the cardiac glycofides have been elucidated as a result of the development of assays of sufficient sensitivity to measure the concentration of digitalis compounds in biological fluids. Digoxin can accumulate in the body without the administration of a loading dose, and a steady state blood concentration will be reached in 5 to 7 days. Digitoxin requires 35 days to accumulate to a plateau. If a loading dose of digoxin is used, it should be approximately three times the estimated daily maintenance dose. Factors that determine the selection of the appropriate maintenance dose of digoxin include renal function and lean body mass. Digitoxin is less dependent on renal function for its elimination than is digoxin. Knowledge of the pharmacokinetics of digitalis preparations is useful in determining how to change from one cardiac glycoside to another, each with different half-lives. One should wait 3 days before starting digoxin therapy when changing from maintenance digitoxin to digoxin (assuming normal renal function). The pharmacokinetics of changing from ouabain to digoxin without loss of digitalis effect are described. The metabolism of the commonly used digitalis preparations are summarized.

Topics: Atrial Fibrillation; Creatinine; Delayed-Action Preparations; Digitalis Glycosides; Digitoxin; Digoxin; Electrocardiography; Feces; Half-Life; Heart Failure; Humans; Kidney; Kinetics; Ouabain; Time Factors

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Atrioventricular Node; Diagnosis, Differential; Digitalis Glycosides; Digitoxin; Digoxin; Heart Diseases; Heart Rate; Heart Ventricles; Humans; Myocardium; Poisoning; Radioimmunoassay

Topics: Administration, Oral; Animals; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiac Catheterization; Cardiac Surgical Procedures; Coronary Disease; Depression, Chemical; Digitalis; Digoxin; Heart; Heart Diseases; Humans; Injections, Intravenous; Ouabain; Phenytoin; Plants, Medicinal; Plants, Toxic; Ventricular Fibrillation

Topics: Adult; Atrial Fibrillation; Child, Preschool; Death, Sudden; Digitalis; Electric Stimulation; Electrocardiography; Electrophysiology; Heart Conduction System; Humans; Infant; Infant, Newborn; Phytotherapy; Plants, Medicinal; Plants, Toxic; Prognosis; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Coronary Disease; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Tachycardia, Paroxysmal

Topics: Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digitalis; Digitalis Glycosides; Digoxin; Electrocardiography; Heart Block; Heart Failure; Humans; Isoproterenol; Lanatosides; Mitral Valve Stenosis; Pacemaker, Artificial; Tachycardia; Thoracic Surgery; Toxicology; Ventricular Fibrillation

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digitalis; Digitalis Glycosides; Drug Therapy; Heart Block; Humans; Tachycardia; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

In heart failure, digitalis increases exercise capacity and reduces morbidity, but has no effect on survival. This raises the suspicion that the inotropic benefits of digitalis may be counteracted by serious adverse effects. Patients with atrial fibrillation (AF) were studied to clarify this.. In the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation (SPORTIF) III and V studies, 7329 patients with AF at moderate-to-high risk were randomised to preventive treatment of thromboembolism, either with warfarin or the oral direct thrombin inhibitor ximelagatran. The survival of users and non-users of digitalis was investigated.. At baseline, 53.4% of the study population used digitalis, and these patients had a higher mortality than non-users (255/3911 (6.5%) vs 141/3418 (4.1%), p<0.001; hazard ratio (HR) = 1.58 (95% CI 1.29 to 1.94)). Digitalis users also had more baseline risk factors. After multivariate risk factor adjustment, the increased mortality persisted (p<0.001; HR = 1.53 (95% CI 1.22 to 1.92 vs 1.23 to 1.92)).. The results suggest that digitalis, like other inotropic drugs, may increase mortality. This may be concealed in heart failure, but be revealed in patients with AF, who need the rate-reducing effect of digitalis, but do not benefit much from an increased inotropy. Cautious interpretation of the data is mandatory since the patients were not randomised with respect to digitalis use.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Azetidines; Benzylamines; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Double-Blind Method; Female; Humans; Kaplan-Meier Estimate; Male; Phytotherapy; Plant Preparations; Stroke; Thromboembolism; Warfarin

Although digoxin is often the drug of choice to control the ventricular response in chronic atrial fibrillation, it fails to control exercise-induced increase in heart rate. The efficacy of diltiazem to control ventricular response and to improve cardiovascular performance during maximal exercise was investigated in 13 digitalized patients with chronic atrial fibrillation. A placebo controlled prospective randomized double-blind study, was preceded by open titration phase. During the diltiazem treatment phase, mean ventricular response diminished at rest (85 +/- 12 versus 107 +/- 19 during digoxin therapy and versus 101 +/- 18 during digoxin and placebo therapy; p less than 0.001), as well as during maximal exercise (142 +/- 13 versus 159 +/- 17 during digoxin treatment and versus 160 +/- 14 during digoxin plus placebo treatment; p less than 0.001). During exercise (50 W), in a subgroup of 7 patients, mean ventricular rate dropped: 109 +/- 19 versus 142 +/- 21 during digoxin treatment and versus 143 +/- 17 during digoxin plus placebo treatment; p less than 0.001). In all patients, the mean rate at rest decreased about 19.3 +/- 6.9% and at maximal exercise about 10.3 +/- 4.9%. In the subgroup of the 7 patients ventricular mean rate at a load of 50 W decreased about 23.6 +/- 7.9%. In all the patients, maximal exercise capacity improved: the MET mean value increased from 3.59 +/- 1.3 to 4.52 +/- 1.18 (p less than 0.001); the mean value of the maximum exercise (MEC), according to the Redfords formula, increased from 65 +/- 48 to 132 +/- 70 (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Fibrillation; Chronic Disease; Depression, Chemical; Digitalis; Digoxin; Diltiazem; Double-Blind Method; Drug Evaluation; Female; Heart Rate; Heart Ventricles; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Random Allocation

The indication for digitalis treatment was investigated in a controlled and prospective study lasting 12 months in 110 patients on long-term haemodialysis. In ten patients, digitalis was needed because of tachyarrhythmia due to atrial fibrillation and in five because of recurrent pulmonary edema. In 57 patients receiving digitoxin, therapy was discontinued for 4 to 6 weeks, whereas 13 patients not yet treated with digitalis, received digitoxin for 4 weeks. Without digitoxin, trial fibrillation occurred in 4 patients, while no patient experienced atrial fibrillation with digitoxin (P = 0.002). In 13 patients, radiological findings (heart enlargement, pulmonary congestion) were better with digitoxin than without. Thus digitoxin appeared to be clearly indicated in 29% of the haemodialysed patients. Additionally, digitalis was indicated in 31 patients because of heart enlargement, pulmonary congestion and (or) previous pulmonary edema. Initially, 76% of the patients were receiving digitoxin, whereas, after the investigation, the rate was only 57% (P less than 0.001). The prospective frequency of clinically apparent digitoxin intoxication was low (3%) and so were the overall toxic plasma digitoxin levels (5%). Digitalis should be given deliberately but not restrictively to haemodialysis patients, since atrial fibrillation (13%) and heart failure (50%) are frequent and often concealed.

Topics: Adult; Aged; Atrial Fibrillation; Cardiomegaly; Clinical Trials as Topic; Digitalis; Digitoxin; Digoxin; Female; Heart Rate; Humans; Kidney Failure, Chronic; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Pulmonary Edema; Renal Dialysis; Tachycardia; Time Factors

The safety and efficacy of oral verapamil to control exercise tachycardia in 27 patients with atrial fibrillation and 3 with atrial flutter receiving digitalis was evaluated in a double-blind, randomized, crossover study. The heart rate in patients who received verapamil compared with placebo group was lower at rest (mean 69 +/- 13 versus 87 +/- 20 beats/min, p less than 0.01), as was the degree of tachycardia at the end of 3 minutes of a standardized exercise test (104 +/- 14 versus 136 +/- 23 beats/min, p less than 0.01). Doses of verapamil required to achieve suppression of tachycardia were 240 mg/day in 18 patients, 320 mg/day in 6 patients, and 480 mg/day in 3 patients. Only 3 patients complained of adverse effects from verapamil during the double-blind phase of the study. Two patients were discontinued from the study because of adverse reactions. No clinically significant changes during verapamil therapy were observed on the electrocardiogram, chest roentgenogram, echocardiogram or in the laboratory evaluation. Digoxin blood levels were higher in patients who received concomitant verapamil compared with placebo (1.23 +/- 0.59 versus 0.85 +/- 0.46 ng/ml, p less than 0.01), but no patient had signs or symptoms of digitalis toxicity. Thus, oral verapamil given in addition to digitalis is a safe and effective agent in the treatment of patients with chronic atrial fibrillation or flutter to decrease exercise-induced tachycardia.

Topics: Administration, Oral; Adult; Aged; Atrial Fibrillation; Atrial Flutter; Chronic Disease; Clinical Trials as Topic; Digitalis; Digoxin; Double-Blind Method; Female; Humans; Male; Middle Aged; Physical Exertion; Placebos; Plants, Medicinal; Plants, Toxic; Random Allocation; Tachycardia; Verapamil

Clinical open trials of beta-methyldigoxin were carried out in 15 institutions in order to examine the effect, usefulness and ease of its oral administration. In the case of oral digitalization with 0.2 mg, 3 times daily, an effect was obtained in all of 13 cases of congestive heart failure accompanied by atrial fibrillation or flutter. The average time and dose required for digitalization were about 50 hours and 1.27 mg respectively. In 9 of the 13 cases, the effect was achieved within 48 hours. The average maintenance does of beta-methyldigoxin in 102 cases of congestive heart failure with atrial fibrillation was 0.177 mg per day. About 75% of the cases were maintained with 0.15 to 0.2 mg. This range of dose of beta-methyldigoxin was much smaller than that of digoxin in our series. This can be ascribed to a higher absorption rate of beta-methyldigoxin from the digestive tract. Studies on the cases in which patients previously treated with other glycosides were switched over to beta-methyldigoxin revealed that 1 mg of beta-methyldigoxin is equivalent to 1.8 mg of digoxin or to 0.59 mg of digitoxin. The usefulness and ease of beta-methyldigoxin in maintenance was evaluated as being somewhat superior to other cardiac glycosides, according to the global judgement of the physicians. The observed side effects were similar to those of other glycosides in frequency and character.

Topics: Administration, Oral; Adult; Aged; Atrial Fibrillation; Clinical Trials as Topic; Digitoxin; Digoxin; Dose-Response Relationship, Drug; Female; Heart Failure; Humans; Lanatosides; Male; Middle Aged; Proscillaridin

Topics: Atrial Fibrillation; Clinical Trials as Topic; Digitalis; Electrocardiography; Female; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Creatinine; Digitalis; Digoxin; Dyspnea; Edema; Female; Heart Failure; Humans; Male; Middle Aged; New York; Phytotherapy; Placebos; Plants, Medicinal; Plants, Toxic; Respiratory Insufficiency; Skilled Nursing Facilities; Time Factors

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Bradycardia; Cardiac Complexes, Premature; Cardiomegaly; Clinical Trials as Topic; Coronary Disease; Digitalis Glycosides; Digitoxin; Heart Aneurysm; Heart Failure; Heart Valve Diseases; Humans; Hypertension; Kidney Diseases; Lung Diseases; Middle Aged; Spinal Diseases; Tablets; Tachycardia

New-onset of atrial fibrillation (NOAF) in critically ill patients is the most common acute cardiac dysrhythmia, but evidence-based data regarding treatment strategies are scarce. In this retrospective monocentric study, we compared effectiveness of amiodarone versus digitalis for heart rate control in critically ill patients with new-onset of atrial fibrillation. We identified a total of 209 patients for the main analysis. Amiodarone as compared to digitalis was associated with a clinically relevant faster time to heart rate control < 110 bpm (2 h (IQR: 1 h to 6 h) versus 4 h (2 h to 12 h); p = 0.003) and longer durations of sinus rhythm during the first 24 h of treatment (6 h (IQR: 6 h to 22 h) versus 0 h (IQR: 0 h to 16 h); p < 0.001). However, more bradycardic episodes occurred in association with amiodarone than with digitalis (7.7% versus 3.4%; p = 0.019). Use of amiodarone was associated with an increase of noradrenalin infusion rate compared to digitalis (23.9% versus 12.0%; p = 0.019). Within the tertile of patients with the highest CRP measurements, amiodarone treated patients presented with a higher decrease in heart rate than digoxin treated patients. Clinical trials comparing different NOAF treatment strategies are much needed and should report on concomitant sympathetic activity and inflammatory status.

Topics: Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Critical Illness; Digitalis; Digoxin; Female; Heart Rate; Humans; Inflammation; Male; Middle Aged; Propensity Score; Retrospective Studies; Sepsis; Treatment Outcome

Dronedarone may increase digoxin plasma levels through inhibition of P-glycoprotein. Using real-world data, we evaluated the risk of digitalis intoxication in concomitant users of dronedarone and digoxin compared digoxin-alone users.. We used the Clinformatics DataMart, a US claims database, to identify adult patients with atrial fibrillation (AF) or atrial flutter (AFL) who concomitantly used dronedarone and digoxin and those who used digoxin alone between July 2009 and March 2016. Digitalis intoxication during follow-up until March 2016 was ascertained using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Adjusted hazard ratios (HR) for digitalis intoxication in concomitant users versus users of digoxin alone were estimated, controlling for age, sex, cohort entry year, number of medical encounters for AF or AFL, history of congestive heart failure, diabetes, hypertension, stroke, myocardial infarction, renal failure, use of drugs interacting with digoxin, and digoxin dose.. Overall, 524 concomitant users and 32,459 users of digoxin alone were identified, among which 3 and 301 events of digitalis intoxication occurred during follow-up, respectively. Incidence rates were 17.25 and 9.17 cases per 1000 person-years, respectively. The adjusted HR for digitalis intoxication in concomitant users versus users of digoxin alone was 1.56 (95% CI, 0.50-4.88; P = 0.45). When digitalis intoxication was defined by ICD-9-CM and ICD-10-CM codes accompanied by laboratory testing for digoxin/digitoxin or hospitalization within 30 days, no events occurred in the concomitant users and 40 events occurred in the users of digoxin alone (incidence rate of 1.22 cases per 1000 person-years).. Concomitant use of dronedarone and digoxin was uncommon in this study, and no significant increase in the risk of digitalis intoxication with concomitant use was found.

Topics: Adult; Atrial Fibrillation; Atrial Flutter; Digitalis; Digoxin; Dronedarone; Humans

Because the influence of digitalis use on the death of patients with non-valvular atrial fibrillation (NVAF) remains controversial, a subanalysis of the J-RHYTHM Registry was performed.Methods and Results:A consecutive series of outpatients with AF from 158 institutions was enrolled and followed for 2 years or until the occurrence of an event. Among 7,406 patients with NVAF, 7,018 (age, 69.7±10.0 years; men, 71.1%) with information on antiarrhythmic drug and digitalis use at baseline were divided into 2 groups based on digitalis use. The influence of digitalis on death was investigated using a propensity score-matching model. In 802 patients treated with digitalis, all-cause death was significantly higher than in 6,216 patients with no digitalis use during the 2-year follow-up period (4.4% vs. 2.4%, unadjusted P<0.001). Digitalis use was significantly associated with all-cause death in the crude model (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.28-2.68, P=0.001). However, after propensity score-matching, the association was not significant (HR 1.31, 95% CI 0.70-2.46, P=0.405). Older age, male sex, heart failure, coronary artery disease, and lower body mass index were significantly associated with all-cause death in NVAF patients treated with digitalis.. Digitalis use was not independently associated with all-cause death, and several clinical confounding factors might contribute to increased mortality in NVAF patients treated with digitalis.

Topics: Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Cause of Death; Cerebrovascular Disorders; Digitalis; Digitalis Glycosides; Female; Humans; Japan; Male; Middle Aged; Prospective Studies; Registries; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

This paper reviews Churchill's illness in Carthage in December 1943. It was characterised by fever that lasted 6 days, left lower lobe pneumonia and two episodes of atrial fibrillation. He was managed in a private villa by Lord Moran, his personal physician, with the assistance of two nurses and the expert advice of colleagues. Sulphadiazine and digitalis leaf were prescribed and Churchill recovered. It is remarkable that, despite the severity of his illness, he continued to direct the affairs of State from his bed.

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Famous Persons; Fever; History, 20th Century; Humans; Male; Pneumonia; Sulfadiazine; Tunisia; United Kingdom

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Digitoxin; Digoxin; Female; Humans; Male; Models, Biological

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Digitoxin; Digoxin; Female; Humans; Male; Models, Biological

The effects of digitalis on mortality in patients with structural heart disease are controversially discussed. We aimed to assess the effects of digitalis administration in implantable cardioverter defibrillator (ICD) recipients.. This retrospective analysis comprises 1020 consecutive patients who received an ICD at our institution and who were followed for up to 10 years (median 37 months). A total of 438 patients were receiving digitalis at the time of ICD implantation and 582 did not. Patients on digitalis were more often in atrial fibrillation and had more often a prolonged QRS duration of ≥120 ms, a severely impaired left ventricular ejection fraction, and higher New York Heart Association (NYHA) classification heart failure. Crude Kaplan-Meier analysis demonstrated significantly higher mortality in patients on digitalis (HR = 2.47; 95% CI 1.87-3.25; P = 0.001). After adjustment for patient characteristics found statistically significant in adjusted Cox regression analysis (age, gender, NYHA classification, and QRS duration of ≥120 ms), a HR of 1.65 remained (95% CI 1.14-2.39; P = 0.01). Patients on digitalis died more often from cardiac arrhythmic and cardiac non-arrhythmic causes than patients not on digitalis (P = 0.04). There was no difference in mortality between patients receiving digitoxin and those receiving digoxin (HR = 1.55; 95% CI 0.74-3.25; P = 0.25).. In this large ICD patient population, digitalis use at baseline was independently associated with increased mortality even after careful adjustment for possible confounders. Digitalis should be used with great caution in this population.

Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Cardiotonic Agents; Cohort Studies; Defibrillators, Implantable; Digitalis Glycosides; Digitoxin; Digoxin; Female; Follow-Up Studies; Heart Failure; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Retrospective Studies; Treatment Outcome

This report examined the role of digitalis pharmacokinetics in helping to guide therapy with digitalis glycosides with regard to converting atrial fibrillation (AF) or flutter to regular sinus rhythm (RSR). Pharmacokinetic models of digitoxin and digoxin, containing a peripheral non-serum effect compartment, were used to analyze outcomes in a non-systematic literature review of five clinical studies, using the computed concentrations of digitoxin and digoxin in the effect compartment of these models in an analysis of their outcomes. Four cases treated by the author were similarly examined. Three literature studies showed results no different from placebo. Dosage regimens achieved ≤11 ng/g in the model's peripheral compartment. However, two other studies achieved significant conversion to RSR. Their peripheral concentrations were 9-14 ng/g. In the four patients treated by the author, three converted using classical clinical titration with incremental doses, plus therapeutic drug monitoring and pharmacokinetic guidance from the models for maintenance dosage. They converted at peripheral concentrations of 9-18 ng/g, similar to the two studies above. No toxicity was seen. Successful maintenance was achieved, using the models and their pharmacokinetic guidance, by giving somewhat larger than average recommended dosage regimens in order to maintain peripheral concentrations present at conversion. The fourth patient did not convert, but only reached peripheral concentrations of 6-7 ng/g, similar to the studies in which conversion was no better than placebo. Pharmacokinetic analysis and guidance play a highly significant role in converting AF to RSR. To the author's knowledge, this has not been specifically described before. In my experience, conversion of AF or flutter to RSR does not occur until peripheral concentrations of 9-18 ng/g are reached. Results in the four cases correlated well with the literature findings. More work is needed to further evaluate these provocative findings.

Topics: Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Digitalis; Digitoxin; Digoxin; Female; Humans; Male; Middle Aged; Models, Biological

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Diabetes Mellitus, Type 2; Digitoxin; Humans; Male

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Blood Glucose; Diabetes Mellitus, Type 2; Digitoxin; Glycated Hemoglobin; Humans; Male

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiotonic Agents; Chronic Disease; Digitalis Glycosides; Digitoxin; Heart Failure; Humans; Radiography

Topics: Anticoagulants; Atrial Fibrillation; Azetidines; Benzylamines; Digitalis; Digoxin; Drug Combinations; Hemorrhage; Humans; Phytotherapy

Topics: Atrial Fibrillation; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Humans; Phytotherapy; Plant Preparations; Safety

Topics: Acute Kidney Injury; Aged; Atrial Fibrillation; Bundle-Branch Block; Digitalis; Digoxin; Electrocardiography; Humans; Male; Metoprolol; Tachycardia, Ventricular

Symptom-limited cardiopulmonary exercise testing was performed in 37 patients with mitral stenosis (MS) without significant coronary artery stenosis to evaluate factors affecting ST depression in exercise electrocardiograms. The degree of ST depression was not associated with gender or exercise tolerance. The incidence of significant ST depression was higher in the patients receiving than in those not receiving digitalis (P < 0.05). In addition, the patients with atrial fibrillation and a higher heart rate response were more likely to have a high prevalence of significant ST depression than those with sinus rhythm and a lower response (P < 0.05). We concluded that atrial fibrillation, a higher maximum heart rate, and oral digitalis administration were involved in ST depression during exercise testing in patients with mitral stenosis without coronary heart disease.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Electrocardiography; Exercise; Exercise Test; Female; Heart Rate; Humans; Male; Middle Aged; Mitral Valve Stenosis

Left atrial enlargement is a risk factor for the development of atrial fibrillation (AF). Large atrial size increases thromboembolic risk and reduces the success rate of cardioversion. The study aim was to evaluate if left atrial size reduction affects cardiac rhythm in patients with chronic AF undergoing mitral valve surgery.. Twenty-seven patients were analyzed prospectively. The left atrial incision was extended to the left inferior pulmonary vein. Left atrial size reduction was achieved by closure of the left atrial appendage from inside with a double running suture. The same suture plicated the left lateral atrial wall to the roof of the left pulmonary vein inflow and the inferior atrial wall. The atrial septum was plicated by placing stitches of the closing suture line across the fossa ovalis. Rhythm, neurological complications, cardioversion, anticoagulation and anti-arrhythmic medication were evaluated at one year postoperatively and at recent follow up (mean 40 +/- 15 months).. At discharge, five patients (19%) were in sinus rhythm (SR). At one year postoperatively, SR was restored in 17 patients (63%), but five (19%) reported episodes of arrhythmia and AF persisted in 10 (37%). At recent follow up, four patients had died and three were lost to follow up. Among 20 patients examined, 13 (65%) had SR but six reported episodes of arrhythmia and AF persisted in seven (35%). LA diameter was significantly reduced, from 60.2 +/- 9.8 mm preoperatively to 44.5 +/- 7.0 mm at one year after surgery.. The addition of left atrial size reduction to mitral valve surgery is technically simple, and was effective in 63% of patients with chronic AF, restoring predominant SR. In order to influence pathogenetic factors other than size, additional ablative steps may further increase the SR conversion rate. Size reduction may also improve the outcome of other ablative approaches.

Topics: Adult; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiac Pacing, Artificial; Cardiopulmonary Bypass; Chronic Disease; Cohort Studies; Digitoxin; Echocardiography; Electric Countershock; Female; Follow-Up Studies; Heart Atria; Heart Conduction System; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve; Postoperative Complications; Sotalol; Survival Analysis; Treatment Outcome; Verapamil

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Digitalis; Digoxin; Drug-Related Side Effects and Adverse Reactions; Electrocardiography; Heart Conduction System; Humans; Male

A 21-year-old woman with known endocardial fibroelastosis diagnosed when aged 3 months was admitted because of progressive dyspnoea. The physical examination revealed symptoms of heart failure, with pulmonary rales, mild hepatomegaly, and tachyarrhythmia.. The electrocardiogram showed atrial fibrillation, complete right bundle branch block and right ventricular hypertrophy. Echocardiography indicated hypertrophy and dilatation of the right ventricle (61 mm) with tricuspid regurgitation and hypoplasia of the left ventricle. Heart catheterization confirmed pulmonary hypertension (60/46 mmHg) as well as dilatation and hypokinesia of the right ventricle. Right ventricular biopsy showed severe myocardial hypertrophy resulting from secondary pulmonary hypertension, while no evidence of myocarditis or idiopathic dilated cardiomyopathy was found.. Symptoms of heart failure improved under medical treatment with digitalis, angiotensin-converting enzyme inhibitor and diuretics.. Primary endocardial fibroelastosis of the contracted type must be included in the differential diagnosis of heart failure occurring in young adults.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Atrial Fibrillation; Cardiac Catheterization; Diagnosis, Differential; Digitalis; Diuretics; Dyspnea; Echocardiography; Electrocardiography; Endocardial Fibroelastosis; Female; Heart Failure; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic

Topics: Atrial Fibrillation; Calcium Channel Blockers; Cardiac Output, Low; Case-Control Studies; Coronary Angiography; Coronary Artery Bypass; Coronary Disease; Digitalis; Diltiazem; Electrocardiography; Female; Hemodynamics; Humans; Logistic Models; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic; Postoperative Complications; Prospective Studies; Risk Factors

Topics: Aged; Atrial Fibrillation; Atrial Flutter; Digitalis; Electrocardiography; Electrocoagulation; Humans; Male; Plants, Medicinal; Plants, Toxic

To assess heart rate variability in chronic atrial fibrillation, 60 patients (20 men, 40 women: mean age 63 +/- 8 years: NYHA 2.0 +/- 0.5) with various cardiac conditions were investigated with 24-hour Holter monitoring during daily life. Twenty-five healthy subjects (5 men, 20 women: mean age 55 +/- 9) were considered as the control group. All patients had "controlled" heart rate (50-90 bpm) on basal ECG, normal hematological and thyroid hormone values, and took digoxin alone (mean dosage 0.22 +/- 0.05 mg). Mean digoxin plasma levels were 0.88 +/- 0.48 ng/ml. Maximum, minimum and average heart rate were quite good during the night but too high during the daytime and far higher than those observed in healthy subjects. In fact, up to 82% of patients (at 9 a.m.) had a maximum heart rate higher than 115 bpm. Pauses between 2.0 and 3.0 sec occurred in 40 out of 60 patients (66%). No patients had pauses longer than 4.0 sec. In our experience, patients in chronic atrial fibrillation "controlled" with digoxin alone showed a daytime heart rate which was often too high. We suggest 24-hour Holter monitoring to detect subgroups that may be treated successfully with digoxin associated with calcium-antagonists or beta-blockers.

Topics: Aged; Atrial Fibrillation; Chronic Disease; Digitalis; Echocardiography, Doppler; Female; Heart Rate; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic

The possible chronotropic and arrhythmogenic effects of newly-developed oral inotropic agents were studied in 60 patients with idiopathic dilated cardiomyopathy (NYHA class II-IV). Changes in heart rates and the incidence of arrhythmias were evaluated using ambulatory electrocardiography. Denopamine 30 and 60 mg (beta 1 agonist), xamoterol 200 and 400 mg (beta 1 partial agonist) and OPC-8212 60, 90 and 120 mg (non-catecholamine) were sequentially administered for 10 +/- 2 months. Denopamine slightly increased heart rate throughout the day. Denopamine 60 mg caused excessive tachycardia in patients with atrial fibrillation, and could be used without digoxin. With xamoterol, maximum heart rate decreased during the daytime, while heart rate increased at night. Xamoterol was highly effective in patients with atrial fibrillation who not only had excessive tachycardia during exercise but marked bradycardia at night. Xamoterol increased the severity of heart failure in two patients who belonged to NYHA class IV, whose heart rates at rest had exceeded 100 beats/min. OPC-8212 did not affect heart rate, and was considered an ideal inotropic agent. None of these agents aggravated arrhythmias or caused sustained ventricular tachycardia. It was concluded that not only the severity of heart failure but the chronotropic and arrhythmogenic effects should be considered when choosing inotropic agents.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiomyopathy, Dilated; Cardiotonic Agents; Circadian Rhythm; Digitalis; Drug Evaluation; Electrocardiography, Ambulatory; Ethanolamines; Female; Heart Rate; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Propanolamines; Pyrazines; Quinolines; Xamoterol

Topics: Atrial Fibrillation; Digitalis; Drug Therapy, Combination; Electrocardiography; Furosemide; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Tachycardia, Supraventricular

Quinidine syncope and factors associated with it are well known among adult patients treated for cardiac arrhythmias. To define factors that may influence the occurrence of syncope in children taking quinidine, the clinical, anatomic, electrocardiographic, roentgenographic and pharmacologic data were compared in six patients with syncope (Group A) and 22 patients without syncope (Group B). There was a significant (chi-square = 10.2, p = 0.001) relation between heart disease and quinidine syncope: all six Group A (syncopal) patients had heart disease whereas 15 of the 22 Group B (non-syncopal) patients had no structural heart disease. In contrast, no significant difference was noted between Group A and Group B patients in mean age (11.4 versus 11.4 years), mean quinidine serum concentration (2.9 versus 2.3 micrograms/ml), mean corrected QT interval before quinidine (0.43 versus 0.40 second) or mean corrected QT interval during quinidine therapy (0.46 versus 0.46 second) or between those taking digitalis and those not. Two of the six Group A (syncopal) patients died during therapy, one 6 days after initiating therapy and one suddenly at home 6 months after beginning quinidine. Another two of the six Group A patients exhibited hypokalemia (both 2.9 mEq/liter) at the time of syncope, 2 weeks and 6 months, respectively, after initiation of quinidine therapy; both survived. Syncope occurred within 8 days of initiation of quinidine therapy in three of the six patients. Sustained ventricular tachycardia was observed during quinidine associated arrhythmia in three of six patients with syncope; nonsustained ventricular tachycardia or complex ventricular ectopic activity while on this therapy was observed before syncope in the other three patients in Group A.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Child, Preschool; Digitoxin; Digoxin; Drug Administration Schedule; Electrocardiography; Heart Diseases; Hemodynamics; Humans; Quinidine; Syncope

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Digitalis; Hematocrit; Humans; Middle Aged; Plants, Medicinal; Plants, Toxic; Quinidine

Topics: Atrial Fibrillation; Digitalis; Heart Failure; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Plants, Medicinal; Plants, Toxic; United Kingdom

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Heart Failure; Humans; Myocardial Infarction; Plants, Medicinal; Plants, Toxic

A variety of acute supraventricular tachycardias may be encountered. In many instances the therapies for these rhythm disturbances overlap, but a rational approach to individual disturbances should be based on an understanding of the anatomy and physiology involved in the individual dysrhythmia. Numerous investigative approaches are underway at present, especially with regard to interruption of arrhythmia pathways by electroshock therapy or surgical therapy. In addition, pacing overdrive may be very effective, especially in patients with reentrant arrhythmias.

Topics: Atrial Fibrillation; Atrial Flutter; Digitalis; Electrocardiography; Electrophysiology; Emergencies; Humans; Plants, Medicinal; Plants, Toxic; Tachycardia, Ectopic Junctional; Tachycardia, Paroxysmal; Tachycardia, Supraventricular; Verapamil; Wolff-Parkinson-White Syndrome

To determine whether treatment with digitalis is associated with decreased survival after acute myocardial infarction (AMI), data from 504 patients who were enrolled in a postinfarction natural history study were analyzed. At the time of discharge, 229 patients (45%) were taking digitalis. After 3 years of follow-up, the cumulative survival rate for patients discharged on a regimen of digitalis was 66%, compared with 87% for those not treated (p less than 0.001). Univariate analysis showed that statistically significant differences existed between the 2 groups with respect to age, previous AMI, left ventricular failure in the coronary care unit, atrial fibrillation in the coronary care unit, peak creatine kinase levels, enlarged heart and pulmonary vascular congestion on the discharge chest x-ray, ventricular arrhythmias and treatment with diuretic, antiarrhythmic and beta-blocking drugs. Survival analysis using Cox's regression model showed that the association between digitalis and decreased survival was of borderline significance after adjustment for atrial fibrillation and left ventricular failure. Serum digoxin concentration was measured in 83% of the patients who took digitalis. Survival was inversely and significantly related to serum digoxin, i.e., the higher the serum digoxin concentration, the lower the long-term survival rate. After adjusting for atrial fibrillation and left ventricular failure, serum digoxin was not significantly related to survival. Taken together with the results of 3 other large, nonrandomized studies of digitalis treatment after AMI, this study suggests that digitalis treatment may have adverse effects on survival during follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Fibrillation; Digitalis; Digoxin; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Plants, Medicinal; Plants, Toxic; Risk

In a review of the records of 81 patients with the discharge diagnosis of digitalis toxicity, I found a preponderance of very old patients, many of whom had anorexia, nausea, and prerenal azotemia. Arrhythmias were common (93%) and reflected enhanced automaticity, enhanced AV block, or both. Atrial fibrillation with complete heart block and a regular junctional rhythm should particularly elicit suspicion of digitalis toxicity. Atrial tachycardia with block is less specific and less frequent.

Topics: Adult; Age Factors; Aged; Anorexia; Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digoxin; Heart Atria; Heart Block; Humans; Middle Aged; Nausea; Plants, Medicinal; Plants, Toxic; Radioimmunoassay; Tachycardia; Uremia

Topics: Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Digitalis; Humans; Plants, Medicinal; Plants, Toxic

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Emergencies; Humans; Plants, Medicinal; Plants, Toxic; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Adult; Aged; Atrial Fibrillation; Chronic Disease; Circadian Rhythm; Digitoxin; Digoxin; Drug Therapy, Combination; Heart Rate; Humans; Medigoxin; Middle Aged; Pindolol; Propranolol

Spontaneous conversion to sinus rhythm after prolonged atrial fibrillation is uncommon, with only 11 recorded cases to our knowledge in the English language literature. We report four cases of spontaneous conversion to an organized atrial rhythm (either sinus rhythm or atrial tachycardia with block) after nine to 16 years of established atrial fibrillation. One case was due to a toxic reaction to digitalis. In the other three cases there was no apparent reason. M-mode and two-dimensional echocardiography in three patients showed an akinetic and noncontractile left atrium in each case. This lends support to an earlier hypothesis that complete fibrosis of the left atrium may be responsible for the conversion from atrial fibrillation.

Topics: Adult; Atrial Fibrillation; Digitalis; Electrocardiography; Female; Heart Atria; Heart Rate; Humans; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Contraction; Plants, Medicinal; Plants, Toxic

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Coronary Disease; Digitoxin; Echocardiography; Female; Humans; Middle Aged; Mitral Valve Prolapse; Phonocardiography; Quinidine

Topics: Atrial Fibrillation; Digitalis; Heart Conduction System; Heart Rate; Humans; Plants, Medicinal; Plants, Toxic; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Electrocardiography; Humans; Plants, Medicinal; Plants, Toxic

Topics: Adolescent; Adult; Aged; Atrial Fibrillation; Digitalis; Electric Countershock; Electrocardiography; Female; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Adult; Aged; Atrial Fibrillation; Circadian Rhythm; Digitoxin; Electrocardiography; Humans; Male; Middle Aged; Sinoatrial Node; Tachycardia, Paroxysmal

Extensive clinical experience indicates that cardioversion is the most effective method now available for terminating cardiac tachyarrhythmias. This procedure is not accompanied by depression of myocardial contractility, conductivity, or excitability, a common sequel to the use of antiarrhythmic drugs. Furthermore, the incidence of complications with cardioversion is low. These features of effectiveness, safety, and simplicity permit cardioversion to be used by the noncardiologist physician, who may be less experienced than a cardiologist in recognizing arrrhythmias. Cardioversion has not reduced the need for antiarrhythmic agents; on the contrary, more such drugs are required to maintain normal sinus rhythm. The problem at present is not the terminating a tachyarrhythmia but in preventing its recurrence.

Topics: Adrenergic beta-Antagonists; Age Factors; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Choice Behavior; Digitalis; Electric Countershock; Electricity; Emergencies; Heart Valve Prosthesis; Humans; Pacemaker, Artificial; Plants, Medicinal; Plants, Toxic; Quinidine; Tachycardia; Ventricular Fibrillation

Topics: Aged; Atrial Fibrillation; Digitoxin; Digoxin; Electrocardiography; Female; Heart Arrest, Induced; Heart Conduction System; Humans; Ligation; Pacemaker, Artificial; Propranolol; Quinidine; Reserpine; Tachycardia

Topics: Age Factors; Aged; Atrial Fibrillation; Cardiac Complexes, Premature; Cardiomegaly; Digitalis; Electrocardiography; Female; Heart Block; Heart Conduction System; Heart Rate; Humans; Male; Myocardial Infarction; Plants, Medicinal; Plants, Toxic

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digitalis; Digoxin; Electric Countershock; Heart Block; Heart Ventricles; Humans; Lidocaine; Myocardial Infarction; Pacemaker, Artificial; Phenytoin; Phytotherapy; Plants, Medicinal; Plants, Toxic; Procainamide; Propranolol; Quinidine; Tachycardia; Tachycardia, Paroxysmal; Ventricular Fibrillation

Topics: Arrhythmia, Sinus; Atrial Fibrillation; Atropine; Digitalis; Electrocardiography; Female; Heart Block; Heart Failure; Humans; Isoproterenol; Male; Pacemaker, Artificial; Phytotherapy; Plants, Medicinal; Plants, Toxic; Prospective Studies; Syncope; Tachycardia

Topics: Atrial Fibrillation; Cardiac Catheterization; Digitoxin; Electrocardiography; Heart Conduction System; Heart Ventricles; Humans; Male; Middle Aged; Pulmonary Embolism; Tachycardia

Topics: Atrial Fibrillation; Biopharmaceutics; Digitoxin; Digoxin; Half-Life; Humans; Tablets; Time Factors

Topics: Atrial Fibrillation; Digitoxin; Electric Countershock; Electrocardiography; Female; Heart Conduction System; Heart Failure; Humans; Ligation; Middle Aged; Pacemaker, Artificial; Recurrence; Sutures; Syncope

Topics: Adult; Aortic Valve Insufficiency; Atrial Fibrillation; Bicarbonates; Blood Proteins; Body Composition; Body Water; Body Weight; Bromine; Cardiac Complexes, Premature; Chlorides; Creatinine; Digitalis; Diuretics; Female; Heart Diseases; Heart Failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Phytotherapy; Plants, Medicinal; Plants, Toxic; Potassium; Potassium Chloride; Potassium Isotopes; Sodium; Sodium Isotopes; Spironolactone; Tachycardia

Topics: Adult; Age Factors; Angiography; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Complexes, Premature; Cardiomyopathies; Coronary Disease; Digitalis; Exercise Test; Female; Heart Diseases; Heart Rate; Heart Valve Diseases; Hemodynamics; Humans; Hypoxia; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic; Statistics as Topic; Tachycardia; Ventricular Fibrillation

Topics: Adult; Aged; Aortic Valve Insufficiency; Arrhythmia, Sinus; Atrial Fibrillation; Cardiac Volume; Digitalis; Electric Countershock; Electrocardiography; Female; Humans; Hypertension; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Infarction; Plants, Medicinal; Plants, Toxic

Topics: Adult; Aged; Aortic Valve Insufficiency; Aortic Valve Stenosis; Arrhythmia, Sinus; Atrial Fibrillation; Cardiac Volume; Digitalis; Electric Countershock; Electrocardiography; Female; Heart Atria; Humans; Male; Methods; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Plants, Medicinal; Plants, Toxic

Topics: Aged; Aminophylline; Atrial Fibrillation; Autopsy; Digitalis; Diuretics; Electrocardiography; Female; Granuloma, Giant Cell; Heart Diseases; Humans; Myocarditis; Phytotherapy; Plants, Medicinal; Plants, Toxic

Topics: Aged; Atrial Fibrillation; Bronchopneumonia; Cardiovascular Diseases; Digitalis; Diuretics; Electrocardiography; Endocarditis, Subacute Bacterial; Female; Heart Block; Heart Failure; Heart Septal Defects; Humans; Myocardial Infarction; Phytotherapy; Plants, Medicinal; Plants, Toxic; Potassium; Pulmonary Heart Disease; Radiography

Topics: Aged; Atrial Fibrillation; Cardiomyopathies; Diagnosis, Differential; Digitalis; Electrocardiography; Geriatrics; Heart Diseases; Heart Failure; Heart Valve Diseases; Humans; Hypertension; Ischemia; Mitral Valve Insufficiency; Phytotherapy; Plants, Medicinal; Plants, Toxic; Ventricular Fibrillation

Topics: Aged; Atrial Fibrillation; Cheyne-Stokes Respiration; Digitoxin; Heart Failure; Heart Ventricles; Humans; Male; Respiration

Topics: Adult; Aged; Antibody Specificity; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Cholesterol; Dehydroepiandrosterone; Digitoxin; Digoxin; Electrocardiography; Estradiol; Female; Heart Block; Heart Failure; Humans; Hydrocortisone; Male; Mathematics; Methods; Middle Aged; Progesterone; Radioimmunoassay; Tachycardia; Testosterone; Tritium

Topics: Administration, Oral; Animals; Atrial Fibrillation; Cardiac Catheterization; Digitoxin; Digoxin; Dog Diseases; Dogs; Electrocardiography; Glycosides; Heart Failure; Heart Function Tests; Heart Ventricles; Injections, Intravenous; Intestinal Absorption; Ventricular Function

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Digitoxin; Electrocardiography; Female; Humans; Male; Middle Aged; Pyridines; Tachycardia, Paroxysmal

Topics: Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Diagnosis, Differential; Digitalis; Edrophonium; Electrocardiography; Heart Conduction System; Heart Rate; Humans; Plants, Medicinal; Plants, Toxic; Tachycardia; Time Factors

Topics: Apnea; Arrhythmia, Sinus; Atrial Fibrillation; Cardiac Complexes, Premature; Cheyne-Stokes Respiration; Digitoxin; Electrocardiography; Heart Block; Heart Conduction System; Heart Rate; Humans; Respiration; Tachycardia

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Glycosides; Digitoxin; Digoxin; Heart Rate; Humans; Mathematics; Strophanthins; Tachycardia

Topics: Atrial Fibrillation; Creatinine; Digitoxin; Digoxin; Dosage Forms; Glycosides; Heart Rate; Humans; Intestinal Absorption; Kidney; Kinetics; Liver; Thyroid Gland; Time Factors; Water-Electrolyte Balance

Topics: Anesthetics, Local; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Barbiturates; Barium; Blood Pressure; Bradycardia; Chlorides; Conjunctiva; Cornea; Depression, Chemical; Digitoxin; Dogs; Electrocardiography; Epinephrine; Heart Rate; Hydrochloric Acid; Hypotension; Imipramine; Irritants; Ouabain; Petroleum; Proadifen; Rabbits; Reflex

Topics: Aged; Atrial Fibrillation; Digitalis; Drug Hypersensitivity; Electric Countershock; Humans; Male; Plants, Medicinal; Plants, Toxic; Quinidine; Thiopental

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digitalis; Electric Countershock; Embolism; Female; Humans; Lidocaine; Male; Phytotherapy; Plants, Medicinal; Plants, Toxic; Quinidine; Tachycardia

Topics: Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Bradycardia; Cardiac Complexes, Premature; Digitoxin; Electric Countershock; Electrocardiography; Electrolytes; Embolism; Female; Heart Failure; Heart Septal Defects, Atrial; Heparin; Humans; Hypokalemia; Intracranial Embolism and Thrombosis; Male; Middle Aged; Mitral Valve Stenosis; Postoperative Complications; Pulmonary Embolism; Quinidine; Spironolactone; Water-Electrolyte Balance

Topics: Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Azathioprine; Cardiomyopathies; Digitoxin; Heart Transplantation; Heart Valve Diseases; Histocompatibility; Humans; Hydrocortisone; Hydroquinones; Male; Methods; Phlebitis; Postoperative Complications; Serum Globulins; Transplantation, Homologous

Topics: Adolescent; Adult; Alcoholic Beverages; Atrial Fibrillation; Blood Glucose; Blood Pressure Determination; Body Weight; Cough; Diet; Digitoxin; Electric Countershock; Electrocardiography; Emotions; Fatigue; Female; Heart; Humans; Hypnotics and Sedatives; Male; Middle Aged; Pain; Posture; Quinidine; Radiography; Rest; Thyroid Function Tests; Vagus Nerve; Vomiting

Topics: Age Factors; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digitoxin; Digoxin; Female; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Postoperative Complications

Topics: Atrial Fibrillation; Digitoxin; Female; Heart Failure; Humans; Hyperthyroidism; Iatrogenic Disease; Middle Aged; Tachycardia

Topics: Atrial Fibrillation; Coronary Disease; Digitalis Glycosides; Digitoxin; Electrocardiography; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Mitral Valve Insufficiency; Rheumatic Heart Disease; Time Factors

Topics: Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Coronary Disease; Digitoxin; Drug Tolerance; Electric Conductivity; Female; Heart Block; Heart Rate; Humans; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Digitoxin; Electric Countershock; Female; Follow-Up Studies; Heart; Heart Function Tests; Humans; Male; Middle Aged; Quinidine; Rheumatic Heart Disease; Tachycardia

Topics: Aged; Arrhythmia, Sinus; Atrial Fibrillation; Coronary Disease; Digitoxin; Electrocardiography; Female; Heart Block; Humans; In Vitro Techniques; Male; Tachycardia

Topics: Adult; Aged; Ammonium Chloride; Atrial Fibrillation; Dicumarol; Digitoxin; Humans; Middle Aged; Organomercury Compounds; Quinidine

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digitalis; Electrocardiography; Heart Rate; Humans; Middle Aged; Monitoring, Physiologic; Plants, Medicinal; Plants, Toxic; Quinidine; Tachycardia

Topics: Atrial Fibrillation; Atrial Flutter; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Electric Countershock; Electrocardiography; Humans; Toxicology; Ventricular Fibrillation

Topics: Aortic Valve Stenosis; Atrial Fibrillation; Blood Pressure; Blood Volume; Cardiac Catheterization; Cardiac Output; Constriction, Pathologic; Digitalis; Dye Dilution Technique; Ethylenediamines; Heart Rate; Hemodynamics; Humans; Mitral Valve Stenosis; Pharmacology; Serum Albumin; Serum Albumin, Radio-Iodinated; Theophylline; Ventricular Function, Left

Topics: Acetyldigitoxins; Arteriosclerosis; Atrial Fibrillation; Coronary Disease; Digitoxin; Geriatrics; Heart Failure; Humans; Hypertension; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiac Complexes, Premature; Digitoxin; Electrocardiography; Humans; Pacemaker, Artificial; Quinidine; Rauwolfia; Tachycardia; Tachycardia, Paroxysmal

Topics: Atrial Fibrillation; Cardiovascular Diseases; Digitoxin; Electric Countershock; Heparin; Quinidine; Tachycardia; Tachycardia, Ventricular; Ventricular Fibrillation

Topics: Adams-Stokes Syndrome; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Digitoxin; Drug Therapy; Electrocardiography; Heart Block; Humans; Isoproterenol; Tachycardia; Tachycardia, Paroxysmal; Toxicology; Ventricular Fibrillation

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Brugada Syndrome; Cardiac Conduction System Disease; Cardiac Surgical Procedures; Digitoxin; Drug Therapy; Heart Block; Heart Conduction System; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Postoperative Complications; Rauwolfia; Tachycardia; Tachycardia, Paroxysmal; Thoracic Surgery

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Surgical Procedures; Digitoxin; Drug Therapy; Mitral Valve Stenosis; Postoperative Complications; Thoracic Surgery

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Electrocardiography; Geriatrics; Heart Block; Humans; Parasystole; Quinidine; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Atrial Fibrillation; Digitalis; Drug Therapy; Electric Countershock; Electric Stimulation Therapy; Quinidine; Toxicology

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Bradycardia; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Arrest; Heart Block; Humans; Myocardial Infarction; Physiology; Sympathomimetics; Ventricular Fibrillation

Topics: Angina Pectoris; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Failure; Humans; Hyperthyroidism; Iodine Isotopes; Morbidity; Mortality; Tachycardia; Tachycardia, Paroxysmal

Topics: Adrenergic Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digoxin; Electrocardiography; Ethanolamines; Geriatrics; Heart Block; Heart Failure; Hypotension; Myocardial Infarction; Nausea; Paresthesia; Sympatholytics; Toxicology; Vertigo; Vomiting

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Brugada Syndrome; Cardiac Conduction System Disease; Chronic Disease; Digitalis; Digitalis Glycosides; Drug Therapy; Electrocardiography; Heart Conduction System; Quinidine; Syncope; Toxicology; Ventricular Fibrillation

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Drug Therapy; Electrocardiography; Heart Conduction System; Humans; Tachycardia; Toxicology

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Drug Therapy; Drug Tolerance; Electrocardiography; Humans; Immune Tolerance

Topics: Atrial Fibrillation; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Drug Therapy; Humans; Plant Extracts

Topics: Atrial Fibrillation; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Electrocardiography; Humans; Plant Extracts

Topics: Atrial Fibrillation; Atrial Flutter; Digitalis; Digitalis Glycosides; Electric Countershock; Electric Stimulation Therapy; Quinidine; Tachycardia, Supraventricular

Topics: Atrial Fibrillation; Catecholamines; Digitalis; Dogs; Epinephrine; Heart Conduction System; Pharmacology; Physiology; Research; Sympathectomy; Sympathetic Nervous System; Toxicology; Vagotomy; Vagus Nerve

Benign familial atrial fibrillation is of rare occurrence. A family in which three members manifested this disorder is reported. Apart from this, all three are in excellent health.The relative frequency of non-familial atrial fibrillation in otherwise well people, free from cardiac and metabolic disorders, is stressed. Only too frequently such cases have been and continue to be labelled with the stigma of serious disease with an unhappy prognosis. Serious injustice may be occasioned in such cases in many respects; for example, in the influence that this medical judgment may have on the insurability of young people so afflicted.Methods of exclusion of organic causes of this disorder are outlined and principles of management and treatment are discussed.

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Genetics; Geriatrics; Pathology; Quinidine

Topics: Atrial Fibrillation; Atrial Flutter; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Failure; Humans; Myocardial Infarction; Pulmonary Edema; Tachycardia; Tachycardia, Paroxysmal

Topics: Arteriosclerosis; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Geriatrics; Gynecomastia; Humans; Male; Mastectomy; Mitral Valve Insufficiency; Pathology; Rheumatic Heart Disease; Toxicology

Topics: Atrial Fibrillation; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Heart Ventricles; Humans; Medical Records; Plant Extracts; Ventricular Fibrillation

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Failure; Humans

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Plant Extracts

Topics: Atrial Fibrillation; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Humans; Plant Extracts; Quinidine

Topics: Atrial Fibrillation; Cardiovascular Diseases; Digitalis; Humans; Plant Extracts

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Atria; Humans; Potassium; Salts; Tachycardia; Tachycardia, Paroxysmal; Tachycardia, Supraventricular

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Block; Humans; Tachycardia; Tachycardia, Supraventricular; Tachycardia, Ventricular

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Diseases; Humans; Plant Extracts

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Brugada Syndrome; Cardiac Conduction System Disease; Digitalis; Digitalis Glycosides; Heart Conduction System; Humans; Quinidine

Topics: Atrial Fibrillation; Atrial Flutter; Cardiovascular Diseases; Digitalis; Humans

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Disease Management; Plant Extracts; Quinidine

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Plant Extracts

Topics: Acetyldigitoxins; Atrial Fibrillation; Digitalis; Heart Failure; Humans

Topics: Acetyldigitoxins; Atrial Fibrillation; Atrial Flutter; Digitalis; Digitalis Glycosides; Plant Extracts

Topics: Atrial Fibrillation; Blood Vessels; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Humans

Topics: Acetyldigitoxins; Atrial Fibrillation; Cardiovascular Diseases; Deslanoside; Digitalis; Digitalis Glycosides; Injections, Intramuscular; Plant Extracts

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Brugada Syndrome; Cardiac Conduction System Disease; Digitalis; Heart Conduction System; Heart Rate; Potassium

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Brugada Syndrome; Cardiac Conduction System Disease; Digitalis; Digitalis Glycosides; Heart Conduction System; Humans; Quinidine

Topics: Atrial Fibrillation; Cardiovascular Diseases; Digitalis; Heart Ventricles; Humans

Topics: Acetyldigitoxins; Atrial Fibrillation; Cardiac Glycosides; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Disease; Heart Diseases; Heart Failure; Humans; Mitral Valve; Tachycardia; Tachycardia, Paroxysmal

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Digoxin; Plant Extracts

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Plant Extracts; Quinidine

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Digoxin; Glycols; Humans; Plant Extracts; Propylene Glycol

Topics: Acetyldigitoxins; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Plant Extracts

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Brugada Syndrome; Cardiac Conduction System Disease; Cinchona Alkaloids; Digitalis; Digitalis Glycosides; Heart Conduction System; Procaine; Sparteine; Ventricular Fibrillation

Topics: Atrial Fibrillation; Bundle-Branch Block; Digitalis; Digitalis Glycosides; Heart Block; Heart Diseases; Humans; Quinidine; Tachycardia

Topics: Atrial Fibrillation; Cardiovascular Diseases; Digitalis; Humans; Plant Extracts; Quinidine

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Lanatosides; Plant Extracts; Tachycardia

Topics: Atrial Fibrillation; Digitalis; Humans; Quinidine

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Failure; Plant Extracts

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Digitoxin; Humans; Plant Extracts

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Digitoxin; Humans; Lanatosides; Plant Extracts

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Humans; Quinidine

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Humans; Plant Extracts

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Brugada Syndrome; Cardiac Conduction System Disease; Digitalis; Digitalis Glycosides; Heart Conduction System; Humans; Lanatosides

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Digitoxin; Humans; Plant Extracts

Topics: Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart; Heart Diseases; Heart Failure; Humans

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Autonomic Nervous System; Digitalis; Digitalis Glycosides; Echocardiography; Humans

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Heart Failure

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digitalis Glycosides; Humans; Strophanthins

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis; Digitalis Glycosides