digoxin and Postoperative-Complications

The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.

Topics: Acute Coronary Syndrome; Algorithms; Anticoagulants; Atrial Appendage; Atrial Fibrillation; Cardiac Pacing, Artificial; Cardiotonic Agents; Catheter Ablation; Coronary Artery Disease; Digoxin; Drug Therapy, Combination; Factor Xa Inhibitors; Fibrinolytic Agents; Hemorrhage; Humans; Magnesium; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Postoperative Complications; ST Elevation Myocardial Infarction; Stroke

Postoperative atrial fibrillation (AF) occurs in 20%-40% of patients undergoing open-heart surgery. Numerous pharmacological and electrical therapies have been used as a prophylaxis to prevent this dysrhythmia. The purpose of this study was to examine the selective use of amiodarone and early cardioversion (CVN) postoperatively to restore normal sinus rhythm (NSR).. A retrospective nonrandomized review of patients who received amiodarone and early electrical CVN (study group) for postoperative AF after coronary artery bypass grafting (CABG) were compared with patients who received nonamiodarone therapies (control group). The study group received 150 mg of amiodarone bolus intravenously and thereafter received an infusion of 1 g over a 24-hour period. If NSR was established within 24 hours, then the intravenous (IV) infusion was continued for another 24 hours with concomitant oral amiodarone overlap. If NSR was not established within 24 hours, then external electrical CVN was performed. After 48 hours, the IV infusion was discontinued and the oral regimen maintained through discharge. Control group patients received either combination digoxin and procainamide or diltiazem. Postoperative beta-blocker administration was instituted in all patients.. Six-hundred forty consecutive CABG patients were examined between July 1995 and June 2003. Postoperative AF developed in 160 of these patients (25%). One-hundred patients constituted the study group and 60 patients represented the control group. Restoration of NSR within 24 and 48 hours occurred in 79 (79%) and 90 patients (90%) for the study group, respectively, compared with 38 (64%) and 44 patients (73%) for the control group, respectively. The presence of NSR at discharge was achieved in 98 study patients (98%) and 50 control patients (83%). The length of stay (LOS) for the study and control patients was 7.4 and 9.1 days, respectively. There was no mortality in either group.. Amiodarone and early CVN was more effective than nonamiodarone therapies with regard to restoring NSR for patients in whom AF developed after elective CABG. A trend toward a decrease in LOS was observed in the study group, but was not statistically significant. The overall LOS using amiodarone therapy with early CVN was similar to postoperative AF for patients in whom the condition did not develop.

Topics: Administration, Oral; Adrenergic beta-Antagonists; Aged; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Combined Modality Therapy; Coronary Artery Bypass; Digoxin; Diltiazem; Drug Therapy, Combination; Electric Countershock; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Length of Stay; Male; Middle Aged; Postoperative Complications; Procainamide; Retrospective Studies; Treatment Outcome

Atrial fibrillation (AF) is the commonest arrhythmia. It presents in distinct patterns of paroxysmal, persistent and chronic AF, and patient management aims differ according to the pattern. In paroxysmal AF, drug treatment with beta-blockers, class Ic and class III agents reduce the frequency and duration of episodes. In persistent AF (recent onset, non-paroxysmal), early cardioversion with either pharmacological agents or by direct current (DC) cardioversion should be actively considered, in those patients who are suitable. Patients most likely to cardiovert and remain in sinus rhythm include those with duration of AF of <1 year, an acute reversible cause, left atrial diameter <50 mm and good left ventricular function on echocardiography. Recent data show that maintenance of sinus rhythm after successful cardioversion is enhanced by the use of class III drugs including amiodarone and dofetilide. In chronic or permanent AF, management is aimed at controlling the ventricular rate response with combinations of digoxin, beta-blockers and calcium antagonists with atrio-ventricular nodal activity (diltiazem and verapamil). There is some debate about the prognostic significance of AF. Certainly AF is associated with an excess mortality but this is largely accounted for by its association with serious intrinsic heart disease and the thrombo-embolic complications of the arrhythmia. Atrial fibrillation is a common default arrhythmia for the sick heart.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Cardiovascular Surgical Procedures; Digoxin; Echocardiography; Electric Countershock; Humans; Postoperative Complications; Prognosis; Risk Factors; Thromboembolism

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Atrial Fibrillation; Cerebrovascular Disorders; Coronary Artery Bypass; Costs and Cost Analysis; Digoxin; Heart Rate; Humans; Postoperative Complications; Risk Factors; Sulfonamides

Topics: Cardiac Surgical Procedures; Cyanosis; Digoxin; Diuretics; Follow-Up Studies; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Postoperative Complications

Topics: Aortography; Carbon Dioxide; Digoxin; Diuretics; Ductus Arteriosus, Patent; Echocardiography; Electrocardiography; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Postoperative Complications; Respiration Disorders

The most frequent arrhythmia after coronary artery bypass surgery is atrial fibrillation (AF). The prevention and treatment of this type of arrhythmia is subobtimal. Digitalis, beta-blockers, diltiazem and amiodarone are the preferred drugs for the treatment. This study was designed to compare the effects of preoperatively started digitalis and atenolol in combination and separately, on the incidence of AF that occurs within 7 days following the operation.. One-hundred and sixty patients who had similar demographic properties were randomly grouped as group I, that preoperatively received combined drug therapy (n=40), group II preoperatively used digitalis (n=40), group III atenolol (n=40), and group IV was the control group (n=40).. Postoperative AF incidence was 25, 15,4, and 17,9% in groups IV, III, and II, respectively, whereas it was 5% in group I which was lower than all other groups, but the difference was only significant between groups I and IV (P=0.012).. The combined use of atenolol and digitalis preoperatively was considered as an efficient treatment for lowering the incidence of AF following coronary artery bypass surgery.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Anti-Arrhythmia Agents; Atenolol; Atrial Fibrillation; Coronary Artery Bypass; Digoxin; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication

Neurohormonal activation in children with heart failure due to congenital heart disease leads to downregulation of myocardial beta-receptors that may influence the postoperative course after cardiothoracic surgery.. Myocardial biopsies of 26 children (aged 14+/-4 months) were obtained from the right atrium during cardiac surgery. Patients were allocated to either of two groups based on the duration of their intensive care unit stay: group 1 comprised those who stayed less than 7 days (n = 17), whereas group 2 comprised those who stayed more than 7 days, plus 3 infants who died during the early postoperative course (n = 9). For beta1- and beta2-mRNA quantitation, real-time polymerase chain reaction with fluorescence-labeled products was used.. Values for myocardial beta1-receptor gene expression were twice as high in group 1 children compared with group 2 (beta1-receptor 0.12+/-0.07 versus 0.06+/-0.03, p = 0.0016; beta2-receptor 0.12+/-0.07 versus 0.06+/-0.03, p = 0.0071). Beta-receptor gene expression in 16 children who received standard treatment for heart failure averaged lower than in the 10 children who received additional propranolol.. Beta-receptor downregulation due to congestive heart failure has an impact on the postoperative course in children with congenital disease and depends on heart failure therapy.

Topics: Biopsy; Child, Preschool; Digoxin; Diuretics; Down-Regulation; Drug Therapy, Combination; Female; Heart Defects, Congenital; Heart Failure; Hospital Mortality; Humans; Infant; Length of Stay; Male; Myocardium; Postoperative Complications; Propranolol; Prospective Studies; Receptors, Adrenergic, beta; Risk Factors

This prospective randomized study aims at evaluation and comparison of the prophylactic effects of amiodarone versus digoxin and metoprolol combination in postcoronary bypass atrial fibrillation.. A total of 241 consecutive patients undergoing elective coronary artery bypass grafting were randomly allocated into three groups. Patients in Group1 (n=77) received metoprolol 100 mg/24 h per oral (P.O.), preoperatively, 2x0.5 mg digoxin intravenously on the operating day and digoxin 0.25 mg P.O.+metoprolol 100 mg P.O. on the first postoperative day until discharge. Patients in Group 2 (n=72) received totally 1200 mg intravenous/24 h amiodarone which the 300 mg - bolus dose/1 h was given as soon as the operation had been finished. On the next day patients were administered 450 mg/24 h amiodarone i.v. and 600 mg/day in three doses P.O. were given until discharge. Group 3 (n=92) was the control group with no antiarrhythmic prophylaxis.. Preoperative patient characteristics and operative parameters were similar in three groups. Atrial fibrillation occurred in 13 patients (16.8%) in Group 1, six patients (8.3%) in Group 2 and 31 patients (33.6%) in Group 3.. Both study groups were effective in the prevention of postcoronary bypass atrial fibrillation with respect to control (P<0.01 in Group 1 and P<0.001 in Group 2).

Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Coronary Artery Bypass; Digoxin; Drug Therapy, Combination; Female; Humans; Male; Metoprolol; Middle Aged; Postoperative Complications; Prospective Studies

To evaluate magnesium as a sole or adjuvant agent with currently used prophylactic drugs in suppressing postoperative atrial tachyarrhythmias (POAT) after coronary artery bypass graft (CABG) surgery.. Single-center prospective, randomized clinical trial.. University hospital.. Patients (n = 400) undergoing CABG surgery.. Patients were randomized among 6 prophylaxis regimens: (1) control (no antiarrhythmics), (2) magnesium only, (3) digoxin only, (4) magnesium and digoxin, (5) propranolol only, and (6) magnesium and propranolol. Patients randomized to a regimen including magnesium received 12 g given during 96 hours postoperatively. Patients in a digoxin regimen received 1 mg after cardiopulmonary bypass and 0.25 mg daily. Patients in a propranolol regimen received 1 mg intravenously every 6 hours until able to take 10 mg orally 4 times a day. Prophylaxis regimens were discontinued after 4 days postoperatively.. The primary outcome was a sustained POAT or discharge from the hospital. Control patients had an incidence of POAT (38%) not significantly different from patients in magnesium-only (38%), digoxin-only (31%), and magnesium with digoxin (37%) regimens. Patients treated with propranolol had a significant reduction in POAT. Nearly identical POAT rates in the propranolol-only (18%) and propranolol with magnesium (19%) groups support the lack of efficacy of magnesium in this trial. Study design allowed analysis of and showed a beta-blocker withdrawal effect in addition to suppressive benefit of postoperative beta-blockers.. beta-Blocker prophylaxis is indicated to reduce the incidence of POAT in CABG surgery patients and to prevent a beta-blocker withdrawal effect in patients receiving these medications preoperatively. Digoxin and magnesium as sole or adjuvant agents do not offer suppressive or ventricular rate reduction benefits in POAT.

Topics: Adrenergic beta-Antagonists; Aged; Cardiotonic Agents; Coronary Artery Bypass; Digoxin; Female; Humans; Magnesium; Male; Middle Aged; Postoperative Complications; Propranolol; Prospective Studies; Tachycardia, Supraventricular

Atrial fibrillation (AF) after coronary bypass graft surgery may result in hypotension, heart failure symptoms, embolic complications, and prolongation in length of hospital stay (LOHS). The purpose of this study was to determine whether intravenous diltiazem is more effective than digoxin for ventricular rate control in AF after coronary artery bypass graft surgery. A secondary end point was to determine whether ventricular rate control with diltiazem reduces postoperative LOHS compared with digoxin.. Patients with AF and ventricular rate > 100 beats/min within 7 days after coronary artery bypass graft surgery were randomly assigned to receive intravenous therapy with diltiazem (n = 20) or digoxin (n = 20). Efficacy was measured with ambulatory electrocardiography (Holter monitoring). Safety was assessed by clinical monitoring and electrocardiographic recording. LOHS was measured from the day of surgery. Data were analyzed with the intention-to-treat principle in all randomly assigned patients. In addition, a separate intention-to-treat analysis was performed excluding patients who spontaneously converted to sinus rhythm. In the analysis of all randomly assigned patients, those who received diltiazem achieved ventricular rate control (> or = 20% decrease in pretreatment ventricular rate) in a mean of 10 +/- 20 (median 2) minutes compared with 352 +/- 312 (median 228) minutes for patients who received digoxin (p < 0.0001). At 2 hours, the proportion of patients who achieved rate control was significantly higher in patients treated with diltiazem (75% vs 35%, p = 0.03). Similarly, at 6 hours, the response rate associated with diltiazem was higher than that in the digoxin group (85% vs 45%, p = 0.02). However, response rates associated with diltiazem and digoxin at 12 and 24 hours were not significantly different. At 24 hours, conversion to sinus rhythm had occurred in 11 of 20 (55%) patients receiving diltiazem and 13 of 20 (65%) patients receiving digoxin (p = 0.75). Results of the analysis of only those patients who remained in AF were similar to those presented above. There was no difference between the diltiazem-treated and digoxin-treated groups in postoperative LOHS (8.6 +/- 2.2 vs 7.7 +/- 2.0 days, respectively, p = 0.43).. Ventricular rate control occurs more rapidly with intravenous diltiazem than digoxin in AF after coronary artery bypass graft surgery. However, 12- and 24-hour response rates and duration of postoperative hospital stay associated with the two drugs are similar.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Coronary Artery Bypass; Digoxin; Diltiazem; Double-Blind Method; Electrocardiography, Ambulatory; Female; Heart Rate; Humans; Infusions, Intravenous; Male; Middle Aged; Postoperative Complications; Treatment Outcome; Vasodilator Agents

Prophylactic digitalization is still recommended after open lung surgery in order to prevent cardiac arrhythmias in the postoperative period. Since a beneficial effect of this potentially harmful medication is only poorly documented, we conducted a prospective randomized trial. Patients undergoing elective open lung surgery were divided into two groups one of which received digoxin postoperatively, the other not. Randomization was performed independently in three groups with regard to the extent of surgery, i.e. pneumonectomies in patients of any age, (bi-)lobectomies in patients > 50 and other (less extended) operations in patients > 60. Patients who were either too young for either group or who had already taken digoxin before surgery were followed separately. Monitoring was performed continuously in the ICU and conventional ECG was registered after 24, 48 and 72 hours and weekly until dismission.--Cardiac arrhythmias are very frequent in the early postoperative period with a maximum between the third and the fifth postoperative day. Any kind of arrhythmias were present in 19 of 30 patients (63%) compared to 14 of 35 patients (40%) in the control group. Symptomatic arrhythmias that needed treatment occurred in 11.4% of the control group, but in 33.3% of the patients with prophylactic digitalization. We therefore conclude that a general prophylactic digitalization after open lung surgery is not indicated, but that arrhythmias should be treated individually.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Digoxin; Dose-Response Relationship, Drug; Drug Administration Schedule; Electrocardiography, Ambulatory; Female; Humans; Lung Diseases; Male; Middle Aged; Pneumonectomy; Postoperative Complications; Premedication; Prospective Studies; Thoracotomy

Despite the widespread use of amiodarone in non-surgical patients, its role in the management of supraventricular tachyarrhythmias after cardiac surgery is not clear. We set out to compare the relative efficacy of amiodarone and digoxin in the management of atrial fibrillation and flutter in the early postoperative period. This prospective randomised trial comprised 30 patients, previously in sinus rhythm, who developed sustained atrial fibrillation or flutter following myocardial revascularisation, valve surgery or combined procedures. Amiodarone was administered as an intravenous loading dose followed by a continuous infusion. Digoxin was given as an intravenous loading dose followed by oral maintenance therapy. Electrocardiographic and haemodynamic monitoring was continued for 24 h after the commencement of treatment. There was a marked reduction in heart rate in both groups, mainly in the first 6 h, from 146 to 89 beats per minute in the amiodarone group and from 144 to 95 in the digoxin group. At the end of the 24 h, one of the 15 patients in the amiodarone group and 3 of the 15 patients in the digoxin group remained in atrial fibrillation. No patient in either group developed adverse reactions. We conclude that intravenous amiodarone therapy is safe and at least as effective as digoxin in the initial management of arrhythmias after cardiac surgery.

Topics: Aged; Amiodarone; Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digoxin; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Time Factors

A prospective, controlled, randomized study of 80 patients undergoing esophageal operations was undertaken, in which one group of patients was given digoxin and the other was not. The incidence of cardiac dysrhythmia was compared in each group. Twenty-six patients underwent operation for benign disease. Equal numbers were digitalized or not and no dysrhythmias occurred. Fifty-four patients underwent operation for malignant disease. Of 26 in the group digitalized, 12 suffered dysrhythmia (46%). Of 28 not digitalized, 9 suffered dysrhythmia (32%). Overall, 39% of patients with malignant disease suffered a dysrhythmia compared with none with benign disease (p < 0.002 by chi 2).

Topics: Aged; Arrhythmias, Cardiac; Digoxin; Electrocardiography; Esophageal Diseases; Esophageal Neoplasms; Female; Humans; Intraoperative Complications; Male; Postoperative Complications; Premedication; Thoracotomy

Cardiac arrhythmias are known complications of thoracic operations. The prophylactic value of flecainide administered as a constant-rate, intravenous infusion (0.15 mg.kg-1.h-1) after a loading dose (2 mg.kg-1) was compared with digoxin (10 micrograms.kg-1 for 12 hours, then 0.25 mg.24 h-1) in a randomized study in 30 patients using Holter monitoring during the first 72 hours after operation. Drug monitoring was performed every day to keep a serum level of flecainide of 200 to 600 ng.mL-1 and a digoxin level of 0.8 to 2 ng.mL-1. Failure, defined as the appearance of atrial fibrillation or flutter or the development of complex ventricular arrhythmias (Lown IVb and V), was observed in one patient in the flecainide group (7%) and in 7 patients in the digoxin group (47%) (p less than 0.05). It is concluded that flecainide is more efficient than digoxin in preventing and treating cardiac arrhythmias after thoracic operations. At the dosage used side effects related to flecainide or digoxin were not observed.

Topics: Arrhythmias, Cardiac; Digoxin; Electrocardiography, Ambulatory; Flecainide; Humans; Lung; Postoperative Complications; Thoracic Surgery

Fifty six adult patients were randomised to treatment with flecainide (group 1, n = 29) or a combination of digoxin and disopyramide (group 2, n = 27) for acute atrial fibrillation and flutter after cardiac surgery. Intravenous flecainide was given as a 2 mg/kg bolus over 20 minutes followed by an infusion (0.2 mg/kg per hour) for 12 hours. Group 2 were given digoxin (0.75 mg) intravenously followed two hours later by an intravenous bolus of disopyramide (2 mg/kg) and an infusion (0.4 mg/kg per hour) for 10 hours. Within 12 hours sinus rhythm was restored in 86% of the group 1 (25 patients) and 89% of the group 2 (24 patients). The median time to reversion was significantly shorter in group 1 (80 minutes, range 30-180 minutes) than group 2 (220 minutes, range 138-523 minutes). None of the patients in group 1 and four of the patients in group 2 had transient relapses into atrial fibrillation during the 12 hours of intravenous treatment. There were five late relapses in group 1 and seven in group 2 during subsequent oral treatment. Two group 1 patients and two group 2 patients showed adverse drug effects. Intractable ventricular arrhythmias occurred after five days of oral treatment in one patient (group 1) who had poor left ventricular function, hepatic impairment, and toxic concentrations of drugs at the time of death. Flecainide was as effective as the combination of digoxin and disopyramide and it acted significantly faster and was associated with fewer relapses. Monitoring of blood concentrations of flecainide is essential in patients with poor left ventricular function and hepatic impairment.

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Clinical Trials as Topic; Digoxin; Disopyramide; Drug Therapy, Combination; Female; Flecainide; Humans; Male; Middle Aged; Postoperative Complications; Random Allocation

The efficacy of sotalol in treating acute atrial fibrillation and flutter after open heart surgery was compared with that of a digoxin/disopyramide combination. Forty adult patients with postoperative atrial arrhythmias were randomised into either group 1 (sotalol 1 mg/kg bolus intravenously plus 0.2 mg/kg intravenously over 12 hours) or group 2 (digoxin 0.75 mg intravenously, then two hours later disopyramide 2 mg/kg intravenous bolus and 0.4 mg/kg/h intravenously for 10 hours). In each group, 17 out of 20 patients reverted to sinus or junctional rhythm within 12 hours. The time to reversion in group 1 was significantly shorter than in group 2. Systolic blood pressure fell by greater than or equal to 20 mm Hg or to less than or equal to 90 mm Hg during drug administration in 17 out of 20 patients in group 1 (sotalol withdrawn in two) and in none out of 20 in group 2. Two patients in group 1 developed transient bradycardia (sotalol withdrawn in one). None of 17 patients in group 1 and two of 17 in group 2 relapsed temporarily into atrial fibrillation during the 12 hours of intravenous treatment. On continued oral treatment, one late relapse occurred in group 1 and five in group 2, and five patients in group 2 had disopyramide withdrawn because of anticholinergic side effects (acute urinary retention in four). Sotalol was as effective as the digoxin/disopyramide combination and acted significantly faster. Sensitivity to beta blockade in these patients may be related to high plasma catecholamine concentrations known to occur after cardiopulmonary bypass.

Topics: Atrial Fibrillation; Atrial Flutter; Cardiopulmonary Bypass; Clinical Trials as Topic; Digoxin; Disopyramide; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Postoperative Complications; Sotalol

Supraventricular arrhythmias continue to complicate the postoperative course of patients undergoing myocardial revascularization. In a previous study, we showed a decrease in arrhythmias if patients were given digitalis prior to operation. Since that time we have made two changes-- propranolol is no longer discontinued prior to operation and cold hyperkalemic cardioplegic solution is routinely used. To assess the affect of these changes on arrhythmias, we repeated the previous study. One hundred twenty patients all receiving preoperative and postoperative propranolol were randomized into a control group and a digitalis-treated group. The incidence of supraventricular arrhythmia postoperatively was 21.4% in the control group and 3.1% in the digitalis group (p less than 0.005). Therefore, we continue to advise preoperative digitalization in patients requiring coronary artery bypass and continue to maintain beta blocker and digitalis therapy in the postoperative period.

Topics: Arrhythmias, Cardiac; Clinical Trials as Topic; Coronary Artery Bypass; Digoxin; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Propranolol; Random Allocation

Serious tachydysrhythmias occur in 10% to 30% of patients early after coronary artery bypass grafting (CABG). We studied the effects of digoxin and propranolol in preventing these dysrhythmias over the first week after CABG (average number of grafts, 2.7/patient). Consecutive patients (n = 179) undergoing CABG were randomized to a drug (group 1) or a control (group 2) group. Excluded were patients given digoxin before CABG and those with ejection fractions of less than 40%, those with dysrhythmias within 18 hr after CABG, those being pacer dependent, and those with low-output syndrome after CABG. Risk factors were comparable in both groups. Electrocardiographic examination showed perioperative myocardial infarction in five patients (2.8%). Digoxin (1 mg iv given over 24 hr, then 0.25 mg/day) and propranolol (10 mg given every 6 hr) were started 6 hr after CABG. Supraventricular dysrhythmias requiring treatment occurred in 3.4% of 89 group 1 patients and in 30% of 90 group 2 patients (p less than .001); ventricular dysrhythmias occurred in 1.1% of group 1 and 8.9% of group 2 patients (p less than .01). In this study, a regimen of post-CABG digoxin and propranolol significantly reduced the incidence of supraventricular and ventricular dysrhythmias without causing adverse reactions.

Topics: Aged; Coronary Artery Bypass; Digoxin; Drug Evaluation; Drug Therapy, Combination; Electrocardiography; Humans; Middle Aged; Postoperative Complications; Propranolol; Random Allocation; Tachycardia

The success of prophylactic digitalization in reducing the incidence of supraventricular tachyarrhythmias (SVT) was studied in 140 randomly grouped, consecutive patients undergoing myocardial revascularization operations. The test group received either 1 or 1.5 mg. of digoxin the day before operation and were maintained postoperatively on 0.25 mg. of digoxin daily. There was a significant increase (p less than 0.05) in the incidence of SVT in the treated patients (17 of 61 or 27.8 percent) vs. the untreated patients (nine of 79 or 11.4 percent). There was no significant difference in SVT with the two digitalization dosage levels (31.6 percent with 1 mg. vs. 21.7 percent with 1.5 mg.). Prophylactic digitalization demonstrates no benefit in the prevention of SVT following myocardial revascularization and may, in fact, predispose the patient to these arrhythmias.

Topics: Coronary Artery Bypass; Digoxin; Female; Heart Ventricles; Humans; Male; Middle Aged; Postoperative Complications; Random Allocation; Tachycardia

Topics: Aged; Digitalis Glycosides; Digoxin; Humans; Postoperative Care; Postoperative Complications; Preoperative Care; Time Factors

One hundred and twenty patients undergoing aortocoronary bypass procedures were randomly placed into control and digitalized groups. All were initially in normal sinus rhythm and without evidence of congestive heart failure. Supraventricular arrhythmias occurred in 17 of 66 controls and in only three of 54 digitalized patients (P less than 0.01). There was no evidence of digitals toxicity. Based on this evidence we recommend prophylactic digitalization for patients having aortocoronary bypass operations.

Topics: Arrhythmias, Cardiac; Coronary Artery Bypass; Coronary Disease; Digoxin; Female; Humans; Male; Middle Aged; Postoperative Complications

Topics: Age Factors; Aged; Clinical Trials as Topic; Digoxin; Female; Humans; Male; Placebos; Postoperative Complications; Preoperative Care; Prospective Studies

Topics: Amiodarone; Anti-Arrhythmia Agents; Appendicitis; Belgium; Digoxin; Drug Information Services; Humans; Iatrogenic Disease; Male; Medication Errors; Medication Reconciliation; Middle Aged; Obesity, Morbid; Pharmacists; Postoperative Complications

Topics: Accessory Atrioventricular Bundle; Adult; Catheter Ablation; Digoxin; Electrocardiography; Flecainide; Humans; Male; Postoperative Complications; Tachycardia, Supraventricular; Ventricular Premature Complexes

In the case of severe digoxin intoxication, an antidote digoxin immune Fab (Digibind) is available. Digibind binds and inactivates digoxin. Measuring se-digoxin after administering Digibind (by standard measuring methods) is misleading as Digibind interferes with digitalis immunoassay measurements. The effect of Digibind must be estimated on the basis of the disappearance of the patient's symptoms and cardiac abnormalities. A case involving Fab therapy of a digoxin-overdosed patient is reported.

Topics: Aged; Anti-Arrhythmia Agents; Aortic Aneurysm, Abdominal; Digoxin; Drug Overdose; Humans; Immunoglobulin Fab Fragments; Male; Postoperative Complications; Renal Insufficiency

Topics: Aged; Atrial Fibrillation; Chronic Disease; Contraindications; Coronary Artery Bypass; Digoxin; Drug Interactions; Electrocardiography; Humans; Hypertension; Male; Postoperative Complications; Quinine; Syncope; Tachycardia, Ventricular; Torsades de Pointes; United Kingdom

Topics: Aged, 80 and over; Arrhythmias, Cardiac; Cardiovascular Agents; Colitis, Ischemic; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Digoxin; Drug Therapy, Combination; Female; Humans; Hypertension; Intestinal Mucosa; Nicardipine; Postoperative Complications; Propranolol; Risk Factors; Sigmoid Neoplasms

Surgical intervention is playing an increasingly important therapeutic role in congestive heart failure (CHF) patients with ischemia and dilated cardiomyopathy. Their mitral regurgitation (MR) is a result of left ventricular (LV) geometrical distortion. The optimal type of ring for CHF patients with geometric ventricular-based MR is unknown. This study reviewed the results of flexible versus nonflexible complete mitral valve rings in CHF patients with geometric mitral regurgitation.. Using a prospectively maintained database, patients undergoing mitral valve reconstruction (MVR) with either a flexible or nonflexible complete ring were identified on the basis of preoperative ejection fraction (EF) < or = 30% and no primary mitral pathology. These 2 groups of CHF patients with severe geometric MR were then compared in terms of recurrent MR requiring reoperation. Between 1992 and 2004, 289 patients with EF < or = 30%, received an undersized complete mitral annuloplasty ring as their MVR procedure. Of these, 170 patients had a flexible complete ring. In follow-up, 16 "flexible" patients (9.4%) required a repeat procedure for significant recurrent geometric MR and CHF (10 replacements, 3 re-repairs, 3 transplants). The average time to reoperation was 2.4 years. In contrast, 119 patients with an EF < or = 30% received a MVR using an undersized nonflexible complete ring. Only 3 "non-flexible" patients required a repeat operation, MVR (1), and 2 patients required a transplant. The time to reoperation was 4.0 years. A significant difference in reoperation rates, for recurrent MR, between the 2 groups (P=0.012). There were no differences between groups, in terms of age, ring size used, preoperative EF, LV size, MR grade, or New York Heart Association class.. Patients with CHF having a flexible ring have a higher likelihood of developing recurrent MR requiring reoperation. The use of a nonflexible ring appears to significantly reduce the need for repeat surgical procedures. Further refinement and development of nonflexible ring systems, aimed at LV restoration, deserve ongoing investigation.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Cardiomyopathy, Dilated; Combined Modality Therapy; Databases, Factual; Digoxin; Diuretics; Drug Therapy, Combination; Equipment Design; Female; Follow-Up Studies; Heart Failure; Heart Ventricles; Heart-Assist Devices; Humans; Male; Middle Aged; Milrinone; Mitral Valve; Mitral Valve Insufficiency; Norepinephrine; Pliability; Postoperative Complications; Prospective Studies; Recurrence; Reoperation; Spironolactone; Stroke Volume; Time Factors; Tricuspid Valve Insufficiency; Ultrasonography

Digoxin-immune antibody fragments (Fab) for treatment of digitalis intoxication was introduced in 1976. Many reports have been published concerning this therapy for children, but few have focused on its immediate reversal of cardiac as well as extracardiac life-threatening manifestations of digoxin toxicity. We present a case of life-threatening digitalis intoxication in a child with postoperative renal insufficiency, after a Sennings procedure for transposition of the great arteries. Digoxin administration according to the nationally recommended dosage and intervals unexpectedly resulted in serum levels in the toxic range. Severe cardiac arrhythmias, haemodynamic instability and a rapid-increasing serum potassium level resulted. This report demonstrates how administration of Fab according to the manufacturer's dosage recommendation reversed the tachyarrhythmia immediately and re-established a normal level of serum potassium within minutes.

Topics: Antibodies, Blocking; Antibody Specificity; Cardiac Surgical Procedures; Cardiotonic Agents; Digoxin; Electrocardiography; Female; Humans; Hyperkalemia; Immunoglobulin Fab Fragments; Infant; Postoperative Complications; Potassium; Transposition of Great Vessels

This was a retrospective analysis of patients who had CABG surgery at our hospital over a 12-month period to determine the intermediate-term prognosis of those who had developed PAF after their operation before hospital discharge. Of 317 patients who were operated by a single surgical group, 116 (37%) had AF postoperatively of whom 112 had the paroxysmal form. Of these, 36 were treated with class I or III antiarrhythmic drugs and rate control drugs (group 1) and 76 were treated with rate control alone (group 2). Group 3 consisted of 151 randomly selected patients who did not have AF. All patients were reevaluated at 6 weeks to determine their rhythm and clinical status. Only one patient each in groups 1 and 2 was in AF 6 weeks after discharge. There was a trend toward a higher mortality and morbidity in group 2 patients. PAF after coronary surgery appears to be a self-limited disease process. In this cohort of patients, the rate of recurrence of AF after discharge was similar in patients receiving class I or class III antiarrhythmic drugs together with rate control agents compared to those receiving rate control drugs alone.

Topics: Adrenergic beta-Antagonists; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Case-Control Studies; Coronary Artery Bypass; Digoxin; Female; Follow-Up Studies; Humans; Male; Middle Aged; Morbidity; Postoperative Complications; Prognosis; Random Allocation; Recurrence; Retrospective Studies; Time Factors

This study investigated the association of COPD and postoperative cardiac arrhythmias, specifically supraventricular tachycardia (SVT), as well as mortality in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC).. A retrospective chart review of 244 patients who had undergone lung resection for NSCLC at Indiana University Hospital between 1992 and 1997 was undertaken. COPD, which was defined as an FEV(1) of < or = 70% predicted and an FEV(1)/FVC ratio of < or = 70% based on the results of a preoperative pulmonary function test (PFT), was diagnosed in 78 of the 244 patients (COPD group). In the remaining 166 patients, the results of preoperative PFTs did not meet these criteria (non-COPD group). Both groups were otherwise well-matched with respect to multiple variables, including age, comorbid conditions, extent of pulmonary resection, and final pathologic stage. The incidence of cardiac arrhythmias and operative mortality were compared between the two groups using univariate and multivariate analysis.. Seventy-six patients (31.9%) experienced new onsets of postoperative SVT, with 58 of these patients (76.3%) demonstrating atrial fibrillation. The COPD group had a 58.7% incidence of SVT (n = 44) compared to a 27.0% incidence (n = 44) in the non-COPD group (p < 0.0 0 1). Moreover, following initial digoxin therapy, the COPD group required more second-line antiarrhythmic therapy than did the non-COPD group (66.7% vs 37.8%, respectively; p = 0.0 03). Overall, there were 16 operative deaths (6.6%), and the mortality rate was significantly higher in the COPD group (14.1%) than in the non-COPD group (3.0%; p = 0.0 04). Patients who developed SVT had a significantly longer hospital course than did patients who did not (p < 0.0001). Thirteen of the 16 patients who died experienced SVT; however, SVT was not an independent risk factor for death. Finally, of the 19 variables evaluated, major resection (ie, pneumonectomy and bilobectomy) and COPD were identified as independent risk factors for the development of cardiac arrhythmias (p = 0.0 033 and p = 0.0 009, respectively).. Patients with COPD, as defined by the results of preoperative PFTs, are at significantly higher risk for SVT, and in particular SVT refractory to digoxin, following pulmonary resection for NSCLC. Although SVT was not an independent risk factor for death, a significantly longer hospitalization was observed.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Carcinoma, Non-Small-Cell Lung; Cause of Death; Digoxin; Female; Forced Expiratory Volume; Hospital Mortality; Humans; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Postoperative Complications; Pulmonary Disease, Chronic Obstructive; Risk Factors; Survival Rate; Tachycardia, Supraventricular; Vital Capacity

An analysis of 183 patients in sinus rhythm who underwent coronary artery bypass grafting was conducted to determine the association of multiple preoperative factors, including an elevated left ventricular end-diastolic pressure, with early postoperative atrial fibrillation. An association with advanced age, a history of atrial fibrillation, and preoperative digoxin use was found, but not with an elevated left ventricular end-diastolic pressure, irrespective of left ventricular systolic function.

Topics: Age Factors; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Causality; Coronary Artery Bypass; Digoxin; Female; Humans; Male; Middle Aged; Postoperative Complications; Stroke Volume; Ventricular Function, Left

Atrial fibrillation (AF) is a common complication of coronary artery bypass surgery (CABS). Because conventional antiarrhythmic therapy may cause proarrhythmia, a rate control approach to AF was evaluated in 59 patients post-CABS. The use of digoxin with or without verapamil for AF was associated with spontaneous conversion to normal sinus rhythm in 55 of 59 patients. Two to four weeks later, all patients were on digoxin and 12% were on verapamil, with two of four AF patients having converted to normal sinus rhythm and two others previously in normal sinus rhythm now in AF. A rate control approach to treating AF post-CABS resulted in over 90% of patients being in normal sinus rhythm for two to four weeks after the onset of the arrhythmia.

Topics: Administration, Oral; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Coronary Artery Bypass; Digoxin; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Patient Selection; Postoperative Complications; Time Factors; Verapamil

Topics: Adenosine; Aged; Atrial Fibrillation; Coronary Disease; Diagnosis, Differential; Digoxin; Electrocardiography; Humans; Male; Postoperative Complications; Tachycardia; Verapamil

Topics: Digoxin; Humans; Postoperative Complications; Premedication; Tachycardia, Supraventricular; Thoracotomy

Topics: Adenosine; Digoxin; Electrocardiography; Heart Atria; Heart Conduction System; Humans; Infant, Newborn; Male; Postoperative Complications; Tachycardia, Ectopic Junctional

The estimation of serum digoxin is a usual method in intensive care. In a case report the detection of digoxin-like-immunoreactive-factor (DLIF) is shown, which gives false high levels. DLIF is observed in renal damage, high cardiac activity, pregnancy and newborn.

Topics: Blood Proteins; Cardenolides; Coronary Artery Bypass; Critical Care; Digoxin; Humans; Male; Middle Aged; Postoperative Complications; Respiratory Distress Syndrome; Saponins; Sodium-Potassium-Exchanging ATPase

This study was conducted to ascertain if critical peak body stores of digoxin were needed to protect patients from the debilities that result from supraventricular tachycardias occurring after open heart operations. We gave digoxin peak body stores of 15 micrograms/kg of lean body weight to 100 consecutive patients after open heart operations. If supraventricular tachycardias persisted four hours, we increased peak body stores to 17 or 19 micrograms/kg. The operations included coronary artery bypass grafts, heart valve replacements, and congenital defect correction. After operation, 18 patients had atrial fibrillation or flutter. During supraventricular tachycardias, ventricular rates were 150 beats per minute or slower. In the 100 patients, the median hospital stay after operation was four days. No patient required rehospitalization. The patients who had supraventricular tachycardias stayed in the hospital no longer than the patients who were at all times in regular sinus rhythm. All patients who entered the hospital with regular sinus rhythm went home with regular sinus rhythm. The critical safe peak body stores of digoxin needed to prevent debilities resulting from supraventricular tachycardias after open heart operations were 15 to 19 micrograms/kg of lean body weight.

Topics: Aged; Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digoxin; Female; Humans; Male; Middle Aged; Postoperative Complications; Tachycardia, Supraventricular

Topics: Aorta, Abdominal; Aortic Aneurysm; Aortic Dissection; Digoxin; Drug Interactions; Humans; Male; Middle Aged; Postoperative Complications

A digitalized 75-year-old patient with postoperative renal failure demonstrated a progressive rise in serum digoxin concentration, peaking at 3.4 nmol X L-1 three days following discontinuance of the drug. This was accompanied by cardiac bradyarrhythmias. Although the serum digoxin concentration had already started to climb from a therapeutic level prior to the discontinuance of the drug, the unabated and substantial rise was consistent with a dramatic decrease in the apparent volume of distribution of digoxin accompanying acute renal failure. Serum digoxin levels were determined with fluorescence polarization immunoassay, which has an improved specificity when compared to the commonly used radioimmunoassays for digoxin.

Topics: Acute Kidney Injury; Aged; Arrhythmias, Cardiac; Digoxin; Female; Humans; Kinetics; Postoperative Complications

Topics: Child; Child, Preschool; Chloral Hydrate; Digoxin; Female; Heart Defects, Congenital; Humans; Infant; Isoproterenol; Male; Postoperative Complications; Propranolol; Tachycardia; Verapamil

Prompt control of heart rate is important for successful treatment of supraventricular tachyarrhythmias early after open heart surgery when sympathetic tone is high and ventricular response rates may be rapid. Esmolol, a new ultrashort-acting (9 minute half-life) beta-receptor blocking agent, was given by continuous intravenous infusion for up to 24 hours in 24 patients (21 with isolated coronary bypass surgery and 3 with valve replacement) 1 to 7 days after surgery. Atrial fibrillation was present in 9 patients, atrial flutter in 2 and sinus tachycardia in 13. Eleven patients had received intravenous digoxin (average dose 0.6 mg, average serum level 1.19 mg/100 ml) before esmolol infusion without adequate control of the supraventricular tachyarrhythmia. After a 1 minute loading infusion of esmolol (500 micrograms/kg per min), maintenance dose, titrated to heart rate and blood pressure response, varied from 25 to 300 micrograms/kg per min. After esmolol administration, at an average dose of 139 +/- 83 micrograms/kg per min, mean heart rate decreased from 130 +/- 15 to 99 +/- 15 beats/min. Within 5 to 18 minutes after initiation of therapy, all patients had achieved a 15% reduction in heart rate at a maintenance dose of 150 micrograms/kg per min or less. A 20% reduction in heart rate was attained in 19 of the 24 patients, and conversion to sinus rhythm occurred during esmolol infusion in 5 of the 11 patients with atrial flutter or fibrillation. Transient asymptomatic hypotension (less than 90/50 mm Hg) was seen in 13 patients, requiring cessation of esmolol therapy in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenergic beta-Antagonists; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Blood Pressure; Cardiac Surgical Procedures; Digoxin; Dose-Response Relationship, Drug; Heart Rate; Humans; Hypotension; Infusions, Parenteral; Middle Aged; Postoperative Complications; Premedication; Propanolamines; Tachycardia

Of 1,247 consecutive patients who underwent cardiac surgery, 297 (24%) developed a post-operative atrial tachyarrhythmia. Of these patients, 201 were suitable for treatment according to the study protocol. All patients were initially given digoxin 0.75 mg intravenously (i.v.). After two hours, those 156 patients whose atrial arrhythmias persisted were given a 2 mg/kg loading dose of disopyramide (i.v.), followed by a constant i.v. infusion (0.4 mg kg-1 h-1) or oral therapy (600 mg daily). Within a further 12 hours, 75 patients (48%) reverted to sinus rhythm, 24 within one hour. Thus 120/201 patients (60%) reverted to sinus rhythm within 14 hours of commencing therapy. Reversion rates of those patients with both atrial fibrillation and flutter (AF/AFL) were significantly lower than those with AF (p less than 0.001) or AFL (p less than 0.02) alone. A further 70 patients reverted to sinus rhythm in one to 13 (mean four) days on continued drug therapy. Elective cardioversion restored sinus rhythm in six subjects. Atrial arrhythmias persisted in five patients (2.5%) at hospital discharge. Side-effects of disopyramide were noted in 19% of patients. Urinary retention was common (11.5%). Four patients with atrial flutter developed 1:1 atrioventricular conduction with the disopyramide loading dose. One patient with atrial fibrillation developed ventricular tachycardia during injection of the loading dose of disopyramide, but was successfully cardioverted to sinus rhythm. Two further patients developed significant hypotension (less than 90 mmHg systolic). Disopyramide is effective in the treatment of post-operative atrial tachyarrhythmias, but its routine use in this situation may be associated with an unacceptably high incidence of side-effects.

Topics: Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digoxin; Disopyramide; Drug Therapy, Combination; Heart Conduction System; Humans; Hypotension; Postoperative Complications; Urination Disorders

The authors estimated the influence of corglycon, strophanthin and digoxin on the central hemodynamics indices. Corglycon is recommended for use in urgent situations, while digoxin should be used for prophylactics of cardiac insufficiency.

Topics: Abdomen, Acute; Cardiac Glycosides; Digoxin; Heart Failure; Hemodynamics; Humans; Postoperative Care; Postoperative Complications; Strophanthins; Time Factors

A 13-year-old boy with active tuberculous constrictive pericarditis underwent complete pericardiectomy together with antituberculous therapy and a short course of steroids. Six weeks following the surgery, he was seen with clinical and hemodynamic findings of recurrent pericardial constriction, presumably due to an inflammatory collection around the heart. Symptoms gradually resolved within six months with resumption of steroid therapy. Repeat hemodynamic study showed normal hemodynamics. The case demonstrates the production of cardiac constriction by nonpericardial inflammatory tissue and the possible benefits of steroid therapy in the treatment of tuberculous constrictive pericarditis.

Topics: Adolescent; Antitubercular Agents; Constriction, Pathologic; Digoxin; Diuretics; Humans; Male; Pericarditis, Constrictive; Pericarditis, Tuberculous; Postoperative Complications; Prednisone; Tuberculosis, Cardiovascular

Topics: Cardiac Surgical Procedures; Digoxin; Humans; Postoperative Complications; Premedication; Tachycardia

Topics: Acid-Base Imbalance; Acute Kidney Injury; Blood Volume; Cardiac Surgical Procedures; Cardiac Tamponade; Child; Child, Preschool; Digoxin; Humans; Hypokalemia; Infant; Patient Care Team; Postoperative Care; Postoperative Complications

Among 5,207 adult patients who underwent cardiac surgery, postoperative constrictive pericarditis was recognized in 11 patients (0.2% incidence rate). Seven patients had coronary arterial bypass grafting and 4 had valve replacement; the pericardium was left open in all cases. The average interval between surgery and presentation of pericardial constriction was 82 days (range 14 to 186). M mode echocardiography revealed epicardial and pericardial thickening in 7 cases and variable degrees of posterior pericardial effusion in 5 cases. Cardiac catheterization demonstrated uniformity of diastolic pressures with a characteristic early diastolic dip and late plateau pattern. Two patients responded to medical therapy for chronic pericarditis. One patient had a limited parietal pericardiectomy followed by recurrent constrictive pericarditis that eventually stabilized with medical therapy. The other 8 patients required radical pericardiectomy. The pathophysiology of constriction after surgery is unclear. Its clinical expression involves a wide spectrum of presentation and therapeutic response. Constrictive pericarditis may be a complication of cardiac surgery in spite of an open pericardium and should be considered in postoperative patients who present with deteriorating cardiac function.

Topics: Adrenal Cortex Hormones; Adult; Aged; Cardiac Catheterization; Coronary Artery Bypass; Digoxin; Diuretics; Echocardiography; Electrocardiography; Female; Heart Valve Prosthesis; Hemodynamics; Humans; Male; Middle Aged; Pericarditis, Constrictive; Postoperative Complications

A prospective study of 182 patients undergoing cardiac surgery was performed. The patients were divided into three groups. Group I consisted of 83 patients who had never been treated with digitalis. Group II comprised 59 patients who were taking digoxin before operation and had medication discontinued 24 to 48 hours prior to surgery; they did not receive maintenance digoxin in the postoperative periods. Group III was made up of 40 patients who were given prophylactic digoxin in the perioperative period; none had taken digoxin before. Sixty of 83 group I patients (72%) and two of the group III patients (5%) developed postoperative supraventricular tachyarrhythmia. Digoxin was reinstituted in 56 of group II patients (95%) for supraventricular arrhythmia and/or heart failure. Of the various factors evaluated, only valvular surgery and ECG evidence of myocardial infarction were associated with postoperative supraventricular tachyarrhythmias.

Topics: Adult; Aged; Arrhythmias, Cardiac; Cardiac Surgical Procedures; Digoxin; Female; Humans; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Premedication; Preoperative Care; Prospective Studies

1 A thyrotoxic patient receiving a constant dose of propranolol and digoxin developed marked bradycardia postoperatively. 2 Compared to preoperative levels there was a considerable rise post-operatively in both plasma propranolol and serum digoxin steady-state concentrations. 3 Surgery by effecting drug disposition and disease processes may significantly alter drug handling in the perioperative period.

Topics: Bradycardia; Digoxin; Female; Humans; Metabolic Clearance Rate; Middle Aged; Pharmaceutical Preparations; Postoperative Complications; Propranolol; Surgical Procedures, Operative; Thyroidectomy

Regimens of acute preoperative digitalization have been evaluated previously in the prophylaxis of supraventricular tachycardias (SVT) following coronary artery bypass operations, with equivocal results. This study assesses the effectiveness of immediate postoperative digitalization on the incidence of arrhythmias in 407 consecutive patients recovering from myocardial revascularization. In 137 patients treated by our regimen, which begins digitalization within 4 hours postoperatively, the incidence of supraventricular tachyarrhythmias was 2%, while the corresponding figure for 270 untreated patients was 15%. Digitalization reduced the incidence of supraventricular arrhythmias significantly (p less than 0.01), whereas death, ventricular ectopy, and infarction rates were similar in the two groups. The few patients who did have supraventricular arrhythmias while receiving prophylactic digoxin were no more easily treated than patients in the undigitalized group. The timing of administration of digoxin for SVT prophylaxis may be more important than previously recognized. Immediately postoperative digitalization, theoretically preferable to preoperative regimens, is a safe, effective way to reduce the incidence of supraventricular arrhythmias following myocardial revascularization.

Topics: Arrhythmias, Cardiac; Coronary Artery Bypass; Digoxin; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Postoperative Complications; Postoperative Period; Time Factors

Supraventricular tachydysrhythmia is a bothersome and potentially harmful occurrence after coronary artery bypass graft operation (CABG). Use of digoxin prophylaxis preoperatively has yielded conflicting results in lowering the incidence of supraventricular tachydysrhythmia. In this study, three groups of patients were formed. Group 1 served as the control; no prophylactic medication was given. Group 2 was given digoxin prophylaxis beginning immediately after operation. Group 3 received digoxin postoperatively as did Group 2, plus orally administered propranolol beginning on postoperative day 2. No difference in the incidence of supraventricular tachydysrhythmia was found between Groups 1 and 2 (28.2% versus 28.9%). However, the incidence in Group 3 was 2.2%, and this represented a statistically significant difference (p less than 0.005) compared with either Group or 2. The combined use of digoxin and propranolol postoperatively significantly reduced the incidence of supraventricular tachydysrhythmia after CABG.

Topics: Coronary Artery Bypass; Digoxin; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Postoperative Complications; Propranolol; Tachycardia

Topics: Adult; Arrhythmias, Cardiac; Cardiac Surgical Procedures; Digoxin; Female; Heart Valve Diseases; Heart Ventricles; Humans; Male; Middle Aged; Postoperative Complications

Topics: Adult; Arrhythmias, Cardiac; Digoxin; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Postoperative Complications

Between 1968 and 1977, 87 patients underwent pneumonectomy at Rhode Island Hospital. Postoperatively, 25 patients developed arrhythmia (29 percent), giving rise to hemodynamic deterioration necessitating aggressive treatment. There were nine hospital deaths (10 percent). The effect of preoperative digitalis was analyzed in 68 patients over age 50 years.In Group 1, digoxin was not used until the onset of arrhythmia. There were 40 patients in this group; 18 developed arrhythmia (45 percent) with four deaths (22 percent).In Group 2, patients were given digitalis preoperatively. There were 28 patients; six developed arrhythmia (21 percent) with no deaths.Thus, the high incidence (45 percent in Group 1 and 21 percent in Group 2), as well as risk of mortality (4/18 patients) from arrhythmia following pneumonectomy, in patients over 50 years of age without digitalization, is a strong indication for preoperative digitalis.

Topics: Arrhythmias, Cardiac; Digitalis Glycosides; Digoxin; Humans; Middle Aged; Pneumonectomy; Postoperative Complications

Topics: Adolescent; Adult; Cardiomyopathies; Chagas Disease; Digoxin; Drug Evaluation; Female; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Postoperative Complications

A case is reported in which a Digoxin intoxication led to irregularities in atrial rhythm. This case, which was diagnosed by an intraatrial cardiogram, shows the usefulness of this method which is easy to practise and leads to special therapeutic aid.

Topics: Arrhythmia, Sinus; Arrhythmias, Cardiac; Diagnosis, Differential; Digoxin; Electrocardiography; Heart Atria; Heart Block; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Poisoning; Postoperative Complications; Tachycardia

Ten months after aortic valve replacement (Björk-Shiley prosthesis) a 57-year-old man had thrombotic encapsulation of his prosthetic valve. The only clinical manifestation of this serious complication was gross hemoglobinuria. The management of the patient is described. The slightest change in the condition of a patient after prosthetic valve replacement should be viewed as a possible sign of thrombosis.

Topics: Anticoagulants; Aortic Valve; Digoxin; Heart Valve Prosthesis; Hemoglobinuria; Humans; Male; Middle Aged; Postoperative Complications; Thrombosis

Arrhythmias were analyzed in 50 patients undergoing cardiac surgery: 27 with valve surgery, 15 with coronary artery bypass (CAB), 5 with CAB and valve surgery, and 3 with miscellaneous procedures. The role of electrolyte abnormalities, pericarditis, serum osmolarity, digoxin level, and the type of surgery performed was evaluated. Thirty-seven out of 50 patients (74 per cent) had a postoperative arrhythmia, and a total of 78 different arrhythmias were noted. Twenty-six out of 27 patients with valve surgery had an arrhythmia vs. six out of 15 patients with CAB (p less than 0.001). Atrial fibrillation was the most common arrhythmia in all groups. Although postoperative hypocalcemia, hypomagnesemia, pericarditis, and wide shifts in osmolarity were common, they did not correlate with arrhythmias. Seventeen patients developed postoperative arrhythmias compatible with digitalis toxicity, including junctional rhythm, atrioventricular dissociation, or atrial tachycardia with block. However, the range of serum digoxin levels in these patients was zero to 2.80 ng. per milliliter. This suggests increased sensitivity to digitalis glycosides or the effects of surgical trauma as the etiology of arrhythmia in many patients. The distinction between digitalis-induced arrhythmia and spontaneously occurring arrhythmia cannot be made with certainty in most postoperative patients. Therapy should reflect an awareness of the potential for postoperative digitoxicity.

Topics: Aortic Valve; Arrhythmias, Cardiac; Blood; Bradycardia; Bundle-Branch Block; Calcium; Carbon Dioxide; Cardiac Surgical Procedures; Coronary Artery Bypass; Creatinine; Digoxin; Heart Auscultation; Heart Block; Heart Valve Prosthesis; Humans; Hydrogen-Ion Concentration; Magnesium; Mitral Valve; Osmolar Concentration; Postoperative Complications; Potassium; Serum Albumin; Sodium; Tachycardia, Paroxysmal; Time Factors

Topics: Aged; Anesthesia; Anesthesia, Conduction; Anesthesia, General; Anesthetics; Cardiovascular Diseases; Cardiovascular Physiological Phenomena; Coronary Disease; Digoxin; Emergencies; Geriatrics; Homeostasis; Humans; Kidney; Liver; Metabolism; Nerve Block; Postoperative Care; Postoperative Complications; Preoperative Care; Respiratory Physiological Phenomena; Respiratory Therapy; Respiratory Tract Diseases; Surgical Procedures, Operative; Thromboembolism

Topics: Adolescent; Adult; Digoxin; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve; Postoperative Complications; Time Factors

Topics: Cardiac Glycosides; Digoxin; Heart Failure; Humans; Myocardium; Ouabain; Postoperative Complications; Preoperative Care; Strophanthins

Topics: Aged; Arrhythmias, Cardiac; Bronchial Diseases; Bronchography; Digoxin; Female; Hot Temperature; Humans; Humidity; Lung; Mucus; Positive-Pressure Respiration; Postoperative Complications; Pulmonary Atelectasis; Quinidine; Tomography, X-Ray

Topics: Adipose Tissue; Arrhythmias, Cardiac; Child; Child, Preschool; Creatinine; Digoxin; Extracorporeal Circulation; Heart Defects, Congenital; Humans; Hypokalemia; Muscles; Myocardium; Postoperative Complications; Radioimmunoassay

Topics: Blood Pressure; Carbon Dioxide; Cardiac Catheterization; Cardiac Output; Cryosurgery; Digoxin; Epinephrine; Female; Furosemide; Halothane; Heart; Heart Arrest, Induced; Heart Defects, Congenital; Hemodynamics; Hemoglobins; Humans; Hydrogen-Ion Concentration; Infant; Infant, Newborn; Isoproterenol; Jaundice; Male; Myocardium; Oxygen; Oxygen Consumption; Postoperative Care; Postoperative Complications; Pulmonary Veins; Regression Analysis

Topics: Adult; Age Factors; Aged; Death, Sudden; Digoxin; Diuretics; Female; Graves Disease; Heart Failure; Humans; Hyperthyroidism; Iodine Radioisotopes; Male; Middle Aged; Postoperative Complications; Prognosis; Pulmonary Embolism; Sex Factors; Tachycardia; Thyroid Crisis

Topics: Adolescent; Adrenal Cortex Hormones; Brain Edema; Cardiomegaly; Central Venous Pressure; Cerebrovascular Circulation; Digoxin; Diuretics; Heart Arrest; Heart Atria; Heart Injuries; Hematoma; Humans; Male; Mediastinum; Oxygen Inhalation Therapy; Postoperative Complications; Radiography; Rupture; Thrombosis; Time Factors; Ventilators, Mechanical

Topics: Adult; Aged; Animals; Arrhythmias, Cardiac; Digoxin; Extracorporeal Circulation; Female; Humans; Male; Methanol; Middle Aged; Myocardium; Postoperative Complications; Rabbits; Radioimmunoassay

Topics: Animals; Cardiac Catheterization; Digoxin; Dogs; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Heroin; Humans; Injections, Intravenous; Male; Postoperative Complications; Pseudomonas Infections; Self Medication; Staphylococcal Infections; Substance-Related Disorders; Tricuspid Valve; Tricuspid Valve Insufficiency; Venous Pressure

Topics: Arrhythmias, Cardiac; Child, Preschool; Digoxin; Female; Follow-Up Studies; Heart Arrest; Heart Block; Hemorrhage; Humans; Hypotension; Infant; Male; Methods; Postoperative Complications; Propranolol; Transposition of Great Vessels

Topics: Arrhythmias, Cardiac; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Digoxin; Heart Failure; Humans; Postoperative Care; Postoperative Complications; Premedication; Preoperative Care

Topics: Acetazolamide; Cardiac Glycosides; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Digitoxin; Digoxin; Female; Humans; Hydrocephalus; Infant; Male; Middle Aged; Postoperative Complications; Recurrence

Topics: Adult; Anesthesia; Anesthesia, General; Anesthesia, Inhalation; Anesthesia, Spinal; Arrhythmias, Cardiac; Digoxin; Drug Interactions; Electric Countershock; Extracorporeal Circulation; Humans; Methods; Postoperative Complications; Radioimmunoassay; Time Factors

Topics: Adult; Aortic Valve Insufficiency; Bundle-Branch Block; Carotid Arteries; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Heart Block; Humans; Male; Massage; Middle Aged; Pacemaker, Artificial; Postoperative Complications; Prognosis; Transposition of Great Vessels

Topics: Adolescent; Cardiac Surgical Procedures; Child; Child, Preschool; Digoxin; Hemorrhage; Humans; Infant; Infant, Newborn; Isoproterenol; Methods; Postoperative Care; Postoperative Complications; Stimulation, Chemical; Tetralogy of Fallot

Topics: Aged; Cardiac Glycosides; Digoxin; Electrocardiography; Heart Diseases; Humans; Intensive Care Units; Male; Postoperative Complications; Pulmonary Embolism; Resuscitation; Shock; Surgical Procedures, Operative

Topics: Anti-Bacterial Agents; Antilymphocyte Serum; Arrhythmias, Cardiac; Australia; Azathioprine; Betamethasone; Blood Pressure; Blood Sedimentation; Digoxin; Edema; Electrocardiography; Furosemide; Glycosuria; Heart Auscultation; Heart Transplantation; Hemorrhage; Humans; Hydrocortisone; Hydroxybutyrate Dehydrogenase; Immunosuppressive Agents; Infections; Infusions, Parenteral; Injections, Intramuscular; Injections, Intravenous; Intensive Care Units; Isoproterenol; Male; Middle Aged; Postoperative Complications; Respiration; Transplantation Immunology; Transplantation, Homologous; Veins

Topics: Arrhythmias, Cardiac; Cardiac Surgical Procedures; Digitalis Glycosides; Digitoxin; Digoxin; Electric Stimulation Therapy; Extracorporeal Circulation; Humans; Lidocaine; Myocardium; Perfusion; Phenytoin; Postoperative Complications; Potassium; Tachycardia

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

Topics: Acute Kidney Injury; Aged; Aortic Aneurysm; Atrial Fibrillation; Atrial Flutter; Digoxin; Humans; Male; Middle Aged; Postoperative Complications; Tachycardia

Topics: Adult; Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digoxin; Electric Countershock; Electrocardiography; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Ouabain; Postoperative Complications; Propranolol; Quinidine

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Child, Preschool; Digoxin; Electric Countershock; Electrocardiography; Female; Heart Block; Heart Septal Defects, Atrial; Humans; Hypertension, Pulmonary; Hypothermia, Induced; Male; Postoperative Complications; Quinidine

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Child; Child, Preschool; Digoxin; Heart Defects, Congenital; Heart Diseases; Heart Septal Defects, Atrial; Humans; Lanatosides; Middle Aged; Postoperative Complications; Preoperative Care; Retrospective Studies; Tachycardia

Topics: Digoxin; Electric Countershock; Humans; Intestinal Obstruction; Male; Middle Aged; Postoperative Complications; Potassium Chloride; Quinidine; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Aged; Aortic Valve; Aortic Valve Stenosis; Arrhythmias, Cardiac; Cardiac Catheterization; Cardiac Surgical Procedures; Digoxin; Endocarditis; Endocarditis, Bacterial; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Heart, Artificial; Humans; Isoproterenol; Methicillin; Middle Aged; Postoperative Complications; Psychoses, Substance-Induced; Psychotic Disorders; Thoracic Surgery; Warfarin