digoxin and Sinoatrial-Block

Topics: Adolescent; Arrhythmias, Cardiac; Digoxin; Humans; Long QT Syndrome; Male; Sinoatrial Block

After intravenous application of 1 mg digoxin in a 28-year-old patient with condition after myocarditis by means of premature atrial individual stimulation a SA-block I. type II was observed. Also in extremely premature stimuli the post-extrasystolic pauses remained compensating. After atrial double and multiple stimulation--a new method for the calculation of the sinuatrial conduction time--totally irregular poststimulation pauses appeared, which were regarded as an expression of a sinoauricular node initial block. Other possibilities of explanation are discussed.

Topics: Adult; Cardiac Pacing, Artificial; Digoxin; Heart Block; Humans; Male; Myocarditis; Sinoatrial Block; Sinoatrial Node; Time Factors

To increase the limited knowledge of the effects of digitalis on sinus nodal function in patients with sinus nodal dysfunction and to initiate an investigation into the mechanisms underlying its effects, 34 patients with sinus nodal dysfunction were studied. Twenty patients underwent determination of sinus cycle length, estimated sinoatrial conduction time and maximal corrected sinus recovery time before and after the administration of 0.75 mg of intravenous digoxin. For the group, sinus cycle length did not change, sinoatrial conduction time increased insignificantly and maximal corrected sinus recovery time shortened; however, individual variation occurred. The effects of acute digitalization appeared to predict the effects of chronic digitalis administration on sinus nodal function in the eight patients who subsequently continued to take digoxin. Fourteen patients received digoxin after vagal blockade with atropine. After vagal blockade, digoxin lengthened sinus cycle length, sinoatrial conduction time and maximal corrected sinus recovery time. The effects of digoxin administered after atropine could be antiadrenergic, direct, or both, and are opposite to those induced by atropine alone. Because these effects are similar to those of vagotonia yet are not apparent when the vagi are unblocked, digoxin may have direct excitatory, adrenergic or previously unrecognized vagolytic effects on sinus nodal function in man and their manifestation may be dependent on heart rate or autonomic tone.

Topics: Adult; Aged; Arrhythmias, Cardiac; Atropine; Bradycardia; Cardiac Pacing, Artificial; Digoxin; Electrocardiography; Female; Humans; Injections, Intravenous; Male; Middle Aged; Sinoatrial Block; Sinoatrial Node; Tachycardia; Vagus Nerve