digitoxin and Atrial-Flutter

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: 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

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

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

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

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

Antimalarial drugs are well known for their cardiovascular toxicity. Quinine, the most famous antimalarial agent, mostly causes bradycardia. Quinidine, its dextrorotatory isomer, may cause 1:1 atrioventricular (AV) conduction during atrial flutter. The newly developed drug mefloquine was reported to have fewer cardiac side effects. We describe a 63-year-old male patient with atrial flutter in whom mefloquine use was associated with 1:1 AV conduction, and who then responded to therapy with digoxin and sotalol. The patient had a history of palpitations. This case report emphasizes that mefloquine should be used with caution in patients with a history of palpitations or underlying heart disease.

Topics: Antimalarials; Atrial Flutter; Digitoxin; Drug Therapy, Combination; Heart Conduction System; Humans; Malaria; Male; Mefloquine; Middle Aged; Sotalol

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

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

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

Topics: Aged; Atrial Flutter; Digitalis; Electrocardiography; Humans; Lung Diseases, Obstructive; Male; Plants, Medicinal; Plants, Toxic; Quinidine

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

To study the effect of exercise on atrial flutter the electrocardiogram was recorded continuously before, during and after low level treadmill walking in twenty-two ambulatory patients. Atrial flutter rates increased during exercise testing in four patients. Improved A-V conduction with consequent higher ventricular rates occurred during exercise in thirteen subjects. One patient, with 4:1 conduction at rest, continued with 4:1 block throughout exercise testing, was believed to be over-digitalized. During the recovery period after exercise, ten patients transiently developed periods of Wenckebach A-V block. Walking exercise induced 1:1 conduction in six patients and was promoted by the following circumstances: 1) atrial rates of 250/min or less; 2) inadequate dosage of digitalis; and 3) the administration of quinidine. For the patient with chronic atrial flutter, treadmill testing provides a simple method for demonstrating the range of changes of A-V conduction and for deriving implications for appropriate drug therapy.

Topics: Adult; Aged; Atrial Flutter; Digitalis; Exercise Test; Female; Heart Conduction System; Humans; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Plants, Toxic; Propranolol; Quinidine

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: Adult; Aged; Arterial Occlusive Diseases; Atrial Flutter; Cardiac Output; Digitoxin; Female; Humans; Hyperemia; Intermittent Claudication; Leg; Male; Middle Aged; Plethysmography; Quinidine

Topics: Atrial Flutter; Digitoxin; Humans; Infant; Pharyngeal Diseases

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: Anti-Arrhythmia Agents; Atrial Flutter; Digitalis; Electric Countershock; Electrocardiography; Heart Conduction System; Heart Failure; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic

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: Atrial Flutter; Calcium; Cardiac Complexes, Premature; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Lanatosides; Long-Term Care; Ouabain; Quinidine; Tachycardia

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

Topics: Atrial Flutter; Coronary Disease; Digitoxin; Electrocardiography; Heart Block; 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: Adult; Anti-Arrhythmia Agents; Atrial Flutter; Digitalis; Female; Heart Block; Humans; Injections, Intravenous; Lidocaine; Plants, Medicinal; Plants, Toxic

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

Topics: Arrhythmias, Cardiac; Atrial Flutter; Bradycardia; Digitalis; Digitalis Glycosides; Electrocardiography; Humans; Phytotherapy; Plants, Medicinal; Plants, Toxic; Procainamide; Quinidine; Rauwolfia; Tachycardia; Tachycardia, Paroxysmal

Topics: Atrial Flutter; Digitoxin; Drug Therapy; Electric Countershock; Electrocardiography; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases

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

Topics: Atrial Flutter; Cardiovascular Diseases; Diagnosis, Differential; Digitalis; Digitoxin; Digoxin; Electrocardiography; Humans; Lanatosides; Potassium; Quinidine; Toxicology

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

Topics: Atrial Flutter; Digitalis; Digitalis Glycosides; Electrocardiography; Heart Ventricles; Humans

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

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

Topics: Atrial Flutter; Digitalis; Digitalis Glycosides; Plant Extracts; Sparteine

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

Topics: Atrial Flutter; Cardiovascular Diseases; Digitalis; Heart Block; Heart Ventricles; Humans

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 Flutter; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Incidence; Plant Extracts

Topics: Atrial Flutter; Cardiovascular Agents; Cardiovascular Diseases; Digitalis; Drug-Related Side Effects and Adverse Reactions

Topics: Atrial Flutter; Bundle-Branch Block; Cardiovascular Diseases; Digitalis; Heart Block; Humans; Plant Extracts

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

Topics: Atrial Flutter; Digitalis; Digitalis Glycosides; Drug Overdose; Humans; Plant Extracts; Tachycardia, Supraventricular

Topics: Atrial Flutter; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Heart Rate; Humans; Quinidine

Topics: Atrial Flutter; Cardiovascular Diseases; Digitalis; Digitalis Glycosides; Humans; Quinidine

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

Topics: Atrial Flutter; Digitalis; Digitalis Glycosides; Humans; Plant Extracts; Quinidine

Topics: Anesthesia, Local; Atrial Flutter; Autonomic Nerve Block; Digitalis; Humans; Injections; Stellate Ganglion; Sympathetic Nervous System

Topics: Atrial Flutter; Diarrhea; Digitalis; Digitalis Glycosides; Humans

Topics: Arrhythmias, Cardiac; Atrial Flutter; Digitalis; Digitalis Glycosides; Humans

Topics: Arrhythmias, Cardiac; Atrial Flutter; Digitalis; Heart; Humans; Quinidine