digoxin and Tachycardia--Paroxysmal

Atrial fibrillation (AF), the most common form of sustained arrhythmia, is associated with a frightening risk of embolic complications, tachycardia-related ventricular dysfunction, and often disabling symptoms. Pharmacologic therapy is the treatment used most commonly to restore and maintain sinus rhythm, to prevent recurrences, or to control ventricular response rate.. This article reviews published data on pharmacologic treatment and discusses alternative systems to classify AF and to choose appropriate pharmacologic therapy.. AF is either paroxysmal or chronic. Attacks of paroxysmal AF can differ in duration, frequency, and functional tolerance. In the new classification system described, 3 clinical aspects of paroxysmal AF are distinguished on the basis of their implications for therapy. Chronic AF usually occurs in association with clinical conditions that cause atrial distention. The risk of chronic AF is significantly increased by the presence of congestive heart failure or rheumatic heart disease. Mortality rate is greater among patients with chronic AF regardless of the presence of coexisting cardiac disease. The various options available for the treatment of chronic AF include restoration of sinus rhythm or control of ventricular rate. Cardioversion may be accomplished with pharmacologic or electrical treatment. For patients in whom cardioversion is not indicated or who have not responded to this therapy, antiarrhythmic agents used to control ventricular response rate include nondihydropyridine calcium antagonists, digoxin, or beta-blockers. For patients who are successfully cardioverted, sodium channel blockers or potassium channel blockers such as sotalol, amiodarone, or a pure class III agent such as dofetilide, a selective potassium channel blocker, may be used to prevent recurrent AF to maintain normal sinus rhythm.. The ultimate choice of the antiarrhythmic drug will depend on the presence or absence of structural heart disease. An additional concern with chronic AF is the risk of arterial embolization resulting from atrial stasis and the formation of thrombi. In patients with chronic AF the risk of embolic stroke is increased 6-fold. Therefore anticoagulant therapy should be considered in patients at high risk for embolization. Selection of the appropriate treatment should be based on the concepts recently developed by the Sicilian Gambit Group (based on the specific channels blocked by the antiarrhythmic agent) and on clinical experience gained over the years with antiarrhythmic agents. For example, termination of AF is best accomplished with either a sodium channel blocker (class I agent) or a potassium channel blocker (class III agent). In contrast, ventricular response rate is readily controlled by a beta-blocker (propranolol) or a calcium channel blocker (verapamil). Alternatively, antiarrhythmic drug therapy may be chosen based on the Vaughan-Williams classification, which identifies the cellular electrophysiologic effects of the drug.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Chronic Disease; Digoxin; Dihydropyridines; Drug Administration Routes; Electrocardiography; Embolism; Heart Rate; Humans; Practice Guidelines as Topic; Prognosis; Propranolol; Secondary Prevention; Tachycardia, Paroxysmal; Verapamil

Fetal tachyarrhythmia may constitute a risk for the fetus, therefore early treatment is indicate for all cases of tachydysrhythmia, with or without hydrops, in order to prevent irreversible hydrops. A case report is described of supraventricular paroxysmal tachycardia with digoxin in utero therapy in which pharmacological intervention was successful. Some comments are regarding the experience of the multidisciplinary team at Bissaya-Barreto Maternity in the treatment and orientation of fetal tachydysrhythmias.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Echocardiography; Female; Fetal Diseases; Humans; Pregnancy; Tachycardia, Paroxysmal; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Intravenous antiarrhythmic drugs will continue to have an important role in the acute management of SVT. Long-term antiarrhythmic drug therapy is often effective in preventing or reducing frequency and severity of arrhythmic episodes. The cost, adverse effects, and inconvenience of long-term drug therapy will result in the increasing use of curative ablation for most individuals with problematic SVT.

Topics: Adenosine; Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Calcium Channel Blockers; Digoxin; Electrocardiography; Humans; Potassium Channel Blockers; Sotalol; Tachycardia, Paroxysmal; Tachycardia, Supraventricular

We have reviewed the records of 65 children with paroxysmal supraventricular tachycardia (PST) without congenital heart disease followed a mean of 4 years, with a total of 121 episodes. PST appeared before 6 months of age in 42 (64.6%) children. Thirteen patients (20%) had a present factor which might predispose to PST in 66.2% of the patients who were younger than 6 months of age, and in only 4.3% of those over 6 months. Wolff-Parkinson-White syndrome was present on surface ECG during sinus rhythm in 26.1% of children younger than 6 months, and in 39.1% of those over 6 months. Digoxin was the initial treatment in 84.3% of the episodes with a success rate of 75% when were employed alone and of 84.2% when were employed in combination of quinidine. PST recurred at least once in 35 children (53.8%), the 90% within three months of the first episode. All patients were alive and 63 (96.9%) doing well. One patient developed cerebral anoxia and now has hemiparesia and another patient has incessant PST. We conclude that children with PST without congenital heart disease and without delay in diagnosis had a good outcome.

Topics: Amiodarone; Child; Child, Preschool; Digoxin; Female; Humans; Male; Propranolol; Tachycardia, Paroxysmal; Tachycardia, Supraventricular

The clinical and laboratory findings in and the treatment of congestive heart failure, supraventricular tachycardia, pericardial disease, and hypoxemic spells are discussed.

Topics: Child; Child, Preschool; Digoxin; Emergencies; Heart Diseases; Heart Failure; Humans; Hypoxia; Infant; Infant, Newborn; Pericarditis; Tachycardia, Paroxysmal

Topics: Acute Kidney Injury; Airway Obstruction; Anemia, Hemolytic; Arteriovenous Fistula; Asphyxia Neonatorum; Cardiac Output; Digoxin; Ductus Arteriosus, Patent; Female; Heart Failure; Humans; Hyperthyroidism; Hypoglycemia; Infant; Infant, Newborn; Isoproterenol; Medical History Taking; Pregnancy; Pulmonary Edema; Pulmonary Valve; Sepsis; Streptococcal Infections; Tachycardia, Paroxysmal; Tricuspid Valve Insufficiency

The more recent antiarrhythmic drugs sometimes with more complex action extend the therapeutic possibilities. In addition, numerous other substances are in clinical trial. An ideal antiarrhythmic agent with a reliable action, persistent effective levels, easily absorbable and with few side effects is not found among them. The indication for therapy in ventricular extrasystole is made on the grounds of an ominous ECG criteria and a presumed clinical threat. Controversial results of lidocaine therapy of acute mayocardial infarction are possibly due to pharmacokinetic factors. For "inhomogeneous repolarization" with increased tendency to ventricular fibrillation inducing drugs should be avoided. Malignant cardiac rhythm irregularities possible leading to sudden death require systemic therapeutical testing. In this case, combinations of antiarrhythmic drugs have the highest effectiveness.

Topics: Action Potentials; Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Bretylium Compounds; Calcium; Cardiac Complexes, Premature; Digoxin; Disopyramide; Electrophysiology; Humans; Lidocaine; Mexiletine; Myocardial Infarction; Phenytoin; Quinidine; Tachycardia; Tachycardia, Paroxysmal; Verapamil

Topics: Aged; Anti-Arrhythmia Agents; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Atropine; Bradycardia; Digitalis Glycosides; Digoxin; Heart Block; Heart Ventricles; Humans; Infant; Isoproterenol; Lidocaine; Phenytoin; Potassium; Procainamide; Propranolol; Quinidine; Tachycardia; Tachycardia, Paroxysmal

Topics: Action Potentials; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bradycardia; Digitalis Glycosides; Digoxin; Fever; Heart Atria; Heart Block; Humans; Hypotension; Lung Diseases, Obstructive; Methoxamine; Pacemaker, Artificial; Procainamide; Propranolol; Pulmonary Embolism; Quinidine; Tachycardia; Tachycardia, Paroxysmal; Ventricular Fibrillation

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

Topics: Action Potentials; Cardiac Complexes, Premature; Digoxin; Electrocardiography; Heart; Heart Atria; Heart Conduction System; Heart Ventricles; Humans; Neural Pathways; Pacemaker, Artificial; Procainamide; Prognosis; Quinidine; Sinoatrial Node; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Digoxin is commonly prescribed in symptomatic paroxysmal atrial fibrillation (AF) but has never been evaluated in this condition.. From a multicenter registry, 43 representative patients with frequent symptomatic AF episodes were recruited into a randomized, double-blind crossover comparison of digoxin (serum concentration, 1.29+/-0.35 nmol/L) and placebo. The study end point was the occurrence of 2 AF episodes (documented by patient-activated monitors), censored at 61 days. The median time to 2 episodes was 13.5 days on placebo and 18.7 days on digoxin (P<0. 05). The relative risk (95% CI) of 2 episodes (placebo:digoxin) was 2.19 (1.07 to 4.50). A similar effect was seen on the median time to 1 episode: increased from 3.5 to 5.4 days (P<0.05), relative risk 1. 69 (0.88 to 3.24). The mean+/-SD ventricular rates during AF recordings during placebo and digoxin treatment were 138+/-32 and 125+/-35 bpm, respectively (P<0.01). Twenty-four-hour ambulatory ECG recordings did not show significant differences in the frequency or duration of AF or in ventricular rate.. Digoxin reduces the frequency of symptomatic AF episodes. However, the estimated effect is small and may be due to a reduction in the ventricular rate or irregularity rather than an antiarrhythmic action.

Topics: Ambulatory Care; Anti-Arrhythmia Agents; Atrial Fibrillation; Cross-Over Studies; Digoxin; Dose-Response Relationship, Drug; Double-Blind Method; Electrocardiography; Female; Humans; Male; Middle Aged; Placebos; Tachycardia, Paroxysmal; Treatment Failure

To determine the relative effectiveness of a verapamil-quinidine sequential combination versus digoxin-quinidine in the emergency department treatment of paroxysmal atrial fibrillation (PAF).. This prospective, double-blind, randomized, controlled trial involved patients, aged 18 to 75 years, with new-onset (< 48 hours) atrial fibrillation who presented to a community-based urban hospital with an annual ED census of 65,000. Exclusion criteria included ventricular response rate lower than 100 or higher than 200 beats/minute, allergy to study drugs, hypotension with evidence of end-organ hypoperfusion, and conduction abnormalities. Consenting patients were randomly assigned to receive rapid digitalization (1.0 mg over 2 hours) or i.v. verapamil (sequential 5-mg boluses up to 20 mg). After ventricular rate was controlled (< 100 beats/minute), oral quinidine (200 mg) was initiated and repeated every 2 hours until conversion to normal sinus rhythm (NSR) occurred, until 1 g of quinidine was administered, or until adverse effects supervened. Heart rate, blood pressure, cardiac rhythm, time to conversion, and adverse effects were documented.. Forty-four patients received the study drugs. Three were withdrawn, leaving 19 in the verapamil-quinidine (VER-Q) group and 22 in the digoxin-quinidine (DIG-Q) group. Sixteen patients (84%) in the VER-Q group and 10 (45%) in the DIG-Q group converted to NSR within 6 hours (P < .02). Mean time to conversion (+/-SD) was 185 +/- 146 minutes for VER-Q and 368 +/- 386 minutes for DIG-Q patients (P = NS). Twelve VER-Q patients (63%) and 6 DIG-Q patients (27%) were discharged from the ED (P < .05). Minor adverse effects were more common in the VER-Q group. No mortality or significant morbidity occurred.. The sequential combination of verapamil and quinidine, in the doses studied, is an effective treatment for PAF and is superior to digoxin-quinidine. Digoxin should no longer be considered the treatment of choice for uncomplicated PAF.

Topics: Adult; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Double-Blind Method; Drug Therapy, Combination; Emergency Medical Services; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Prospective Studies; Quinidine; Tachycardia, Paroxysmal; Treatment Outcome; Verapamil

The role of cardiac glycosides for conversion of atrial fibrillation to simus rhythm is controversially discussed. In a prospective study, 45 patients with paroxysmal atrial fibrillation were randomly assigned to one of three treatment groups (of 15 patients each). Group I received oral digoxin, three times 0.125 mg up to twice 0.25 mg daily; group II oral digoxin twice 0.125 mg and quinidine hydrogen sulphate 750-1000 mg daily; group III oral digoxin three times 0.125 mg and flecaimide 200-300 mg daily. During a mean observation period of 11 months, digoxin alone was significantly less effective (p < 0.05) in reducing or suppressing paroxyms of atrial fibrillation than digoxin plus quinidine or flecainide. The use of digoxin remains a mainstay of treatment for rate control in atrial fibrillation. To convert atrial fibrillation to sinus rhythm, however, the addition of a type I or III antiarrhythmic agent is necessary.

Topics: Administration, Oral; Adult; Aged; Atrial Fibrillation; Digoxin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Electrocardiography; Female; Flecainide; Heart Rate; Humans; Male; Middle Aged; Prospective Studies; Quinidine; Tachycardia, Paroxysmal

The effectiveness and electrophysiologic mechanisms of antiarrhythmic effect of digoxin were examined in 27 patients with paroxysmal atrioventricular nodal reciprocal tachycardia (PAVNRT) and supraventricular tachycardia (SVT) due to latent complementary conductive pathways, i. e. latent Wolff-Parkinson-White (WPW) syndrome. To assess antiarrhythmic action of digoxin, transesophageal pacing and plasma digoxin radioimmonoassays were used. Preventive antiarrhythmic efficiency of digoxin was 53% in PAVNRT patients, and 25% in SVT patients with latent WPW syndrome. Antegrade atrioventricular conduction block seems to be the mechanism of oral digoxin preventive effect. There was no relationship between antiarrhythmic efficiency of digoxin and its plasma level.

Topics: Action Potentials; Adolescent; Adult; Anti-Arrhythmia Agents; Atrioventricular Node; Child; Clinical Trials as Topic; Digoxin; Female; Humans; Male; Middle Aged; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Paroxysmal; Tachycardia, Supraventricular

Topics: Adult; Aged; Clinical Trials as Topic; Digoxin; Double-Blind Method; Female; Humans; Male; Middle Aged; Propranolol; Random Allocation; Tachycardia, Paroxysmal; Verapamil

A double-blind cross-over study has been performed in 10 patients with an established diagnosis of paroxysmal suptraventricular tachycardia to compare the effectiveness of three active agents with placebo. The drugs were administered in random sequence for two-week periods with three-day washout intervals and in standard dose regimes as recommended for prophylaxis by authoritative works on the subject. The results suggest that digoxin is ineffective at the recommended dosage. Procaineamide was effective in controlling some arrhythmias, but disopyramide was the most effective agent studied. All these patients showed a mixture of arrhythmias, and also had a lot of ectopic activity. Arrhythmic activity is erratic and unpredictable, and a larger number of patients would need to be studied for long periods of time to obtain enough data for valid statistical assessment.

Topics: Adult; Aged; Clinical Trials as Topic; Digoxin; Disopyramide; Double-Blind Method; Female; Humans; Male; Middle Aged; Placebos; Procainamide; Pyridines; Tachycardia, Paroxysmal

Topics: Child; Clinical Trials as Topic; Digoxin; Diving; Electric Countershock; Female; Humans; Propranolol; Reflex; Tachycardia, Paroxysmal

Topics: Aged; Clinical Trials as Topic; Coronary Disease; Digoxin; Female; Heart Diseases; Humans; Hypertension; Male; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia, Paroxysmal

Topics: Atrial Fibrillation; Bradycardia; Burns; Digoxin; Electrocardiography; Follow-Up Studies; Heart Rate; Humans; Injections, Intravenous; Male; Metoclopramide; Middle Aged; Tachycardia, Paroxysmal

Omeprazole is a commonly prescribed inhibitor of the gastric proton pump and has numerous indications in the treatment of gastrointestinal diseases. It is primarily metabolized through the CYP2C19 enzyme, a member of the P450 mixed-function oxidase group, although a minor pathway of metabolism is through CYP3A4, another P450 enzyme. Digoxin is primarily metabolized outside the P450 system, but a minor pathway of metabolism is by CYP3A4. To our knowledge, this is the first known case of digoxin toxicity associated with omeprazole. The possible pathways for such an interaction are reviewed, including increased stomach absorption, p-glycoprotein activity and interactions in the P450 system.

Topics: Aged; Atrial Fibrillation; Cardiotonic Agents; Digoxin; Drug Interactions; Enzyme Inhibitors; Female; Follow-Up Studies; Gastroesophageal Reflux; Humans; Immunoglobulin Fab Fragments; Omeprazole; Poisoning; Tachycardia, Paroxysmal

Our objective was to assess the efficacy of pharmacological treatment in reducing the incidence of permanent junctional reciprocating tachycardia in young children, or to bring the mean heart rate over 24 h to a normal level. We included 21 children with a median age of 0.05 year seen with permanent junctional reciprocating tachycardia over the period 1990 through 2001. Of these children, two had abnormal left ventricular function. Follow-up visits were made at least every 6 months. We registered the presence of the tachycardia over 24 h, the mean heart rate over 24 h, and cardiac function. Treatment was started with propafenone alone, or in combination with digoxin as the first choice. Treatment was effective in 14 cases (67%), with either complete disappearance of the tachycardia after discontinuation of medication, or continuation in sinus rhythm with medication; partially effective in 4 cases (20%) when the mean heart rate over 24 h on the last Holter recording was less than 1 standard deviation above the normal for age; but was not effective in the remaining 3 cases (14%). In 3 patients treated with propafenone, or 13 given propafenone and digoxin, treatment was effective in 12 (75%), partially effective in 2 (13%), and ineffective in the other 2 (13%). All 21 children had a normal left ventricular function at the end of follow-up. The median duration of follow-up was 2.4 years. Permanent junctional reciprocating tachycardia had disappeared spontaneously in one-third of the children, 5 being less than 1 year old. Adverse effects, seen in 5 cases, were mild or asymptomatic. No signs of proarrhythmia were registered. Pharmacological treatment, either with propafenone alone, or in combination with digoxin, is safe and effective in young children with permanent junctional reciprocating tachycardia. The mean heart rate is normalized, and cardiac function is restored and preserved. Radiofrequency ablation may be delayed to a safer age, with the arrhythmia disappearing spontaneously in one-third.

Topics: Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Logistic Models; Male; Propafenone; Retrospective Studies; Tachycardia, Paroxysmal; Treatment Outcome; Ventricular Function, Left

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Humans; Randomized Controlled Trials as Topic; Tachycardia, Paroxysmal; Treatment Outcome

Gastrointestinal and cardiac manifestations are the commonly considered features of digoxin toxicity. This report describes a patient with severe chronic obstructive lung disease whose primary manifestation of digoxin toxicity is acute alteration of mental status. Neurologic dysfunction may be the sole manifestation of digitalis toxicity. The diagnosis of digoxin toxicity should be considered in elderly patients with altered mental status, even when serum levels are within a therapeutic range.

Topics: Aged; Digoxin; Electrocardiography; Humans; Lung Diseases, Obstructive; Male; Mental Disorders; Tachycardia, Paroxysmal

Seventy consecutive patients hospitalized before 1 year of age for reentrant paroxysmal atrial tachycardia (PAT) were studied according to the age of onset of arrhythmia making 3 distinctive groups: group I: 10 patients in whom onset of the arrhythmia occurred during foetal life; group II: 39 infants whose arrhythmia appeared during the first month of life and group III consisting of 21 patients in whom tachycardia began between 1 and 12 months of age. The characteristics and the consequences of the arrhythmia as well as the patients' course and the different treatments used were analysed. Foetal tachycardias were characterized by a slower heart rate. Episodes were most often short and repetitive as opposed to post-natal tachycardias which were often prolonged but somewhat unfrequent. Before the age of 3 months the occurrence of heart failure was more frequent. Independently of the age of onset, 43% of patients presented Wolff-Parkinson-White syndrome (WPW), which disappeared spontaneously in 1 out of 3 cases. The existence of WPW syndrome was correlated with late relapses.

Topics: Age Factors; Digoxin; Female; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Male; Pregnancy; Prenatal Diagnosis; Tachycardia, Paroxysmal; Time Factors; Wolff-Parkinson-White Syndrome

Serum digoxin concentrations can mislead psychiatric consultants. Two patients with therapeutic digoxin concentrations were seen for neuropsychiatric disorders that cleared rapidly once digoxin was discontinued.

Topics: Aged; Cognition Disorders; Depression; Digoxin; Heart Failure; Humans; Male; Tachycardia, Paroxysmal

To determine the effects of diltiazem hydrochloride on patients with paroxysmal supraventricular tachycardia, we administered intravenous diltiazem, 0.25 mg/kg to patients who presented to the Stanford Medical Center Emergency Department with this rhythm. Blood pressure was recorded prior to administration, and monitored for 20 min thereafter. Six of the ten patients converted to sinus rhythm a mean of 7.75 min (+/- 4.4) after drug administration. The remaining four experienced slowing of heart rates from a mean of 177 to 166 beats/min. Systolic blood pressure fell a mean of 12.4 mmHg during treatment, but returned to pretreatment level or higher within 20 min following diltiazem administration. This mean degree of blood pressure reduction compares favorably with effects produced by intravenous verapamil under comparable circumstances. Intravenous diltiazem appears to be a safe and effective drug for the conversion of paroxysmal supraventricular tachycardia.

Topics: Adult; Atrioventricular Node; Benzazepines; Blood Pressure; Digoxin; Diltiazem; Female; Heart Rate; Humans; Infusions, Parenteral; Male; Middle Aged; Tachycardia, Paroxysmal; Verapamil

Two cases of supraventricular tachycardia responsible for hydrops fetalis emphasize the interest of an antenatal echocardiography. The systematic use of this technique will increase the frequency of diagnosis of this etiology in other cases where the prognosis is less favorable. The in utero treatment of this rhythmic disorder consists in administering Digoxin to the mother and the newborn child must receive excellent care from the moment of the birth.

Topics: Digoxin; Echocardiography; Edema; Female; Fetal Diseases; Humans; Infant, Newborn; Pregnancy; Prenatal Diagnosis; Tachycardia, Paroxysmal; Ultrasonography

Topics: Atrial Fibrillation; Atrial Flutter; Digoxin; Edrophonium; Electric Countershock; Emergencies; Humans; Pressure; Propranolol; Tachycardia, Paroxysmal; Verapamil; Wolff-Parkinson-White Syndrome

Although intracardiac antitachycardial pacing techniques are frequently used to terminate reentrant supraventricular tachycardia in adults, this approach has rarely been used in neonates. We describe two neonates, both of whom were in circulatory shock due to recurrent paroxysmal supraventricular tachycardia, who were treated with temporary antiatachycardial pacing. This approach allows repeated termination of the tachycardia at the bedside until an adequate therapeutic concentration of an effective drug regimen is achieved and obviates repeated direct-current cardioversion.

Topics: Cardiac Pacing, Artificial; Combined Modality Therapy; Digoxin; Drug Therapy, Combination; Electric Countershock; Electrocardiography; Humans; Infant, Newborn; Male; Quinidine; Recurrence; Tachycardia, Paroxysmal; Verapamil

Topics: Digoxin; Electrocardiography; Female; Fetal Diseases; Fetal Distress; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Tachycardia; Tachycardia, Paroxysmal

Topics: Adult; Diagnosis, Differential; Digoxin; Drug Therapy, Combination; Electrocardiography; Heart Block; Heart Conduction System; Humans; Male; Propranolol; Tachycardia, Paroxysmal

Potentialities of the non-invasive method of trans-esophagus electrostimulation of the heart were studied with regard to the selection and assessment of the effectiveness of antiarrhythmic therapy in 16 patients with paroxysms of supraventricular reciprocal tachycardia. The antiarrhythmic therapy selected by this method proved effective in 13 patients following a prolonged course of treatment. The method was highly informative in predicting the efficacy of the systemic course treatment of patients with supraventricular tachycardia paroxysms.

Topics: Adolescent; Adult; Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Digoxin; Drug Evaluation; Electric Stimulation; Female; Humans; Male; Middle Aged; Procainamide; Propranolol; Quinidine; Tachycardia, Paroxysmal; Verapamil

A case is presented of a 21-year-old woman with recurrent paroxysmal supraventricular tachycardia. Electrophysiologic study demonstrated the presence of both antegrade and retrograde dual AV nodal conduction pathways and both conventional slow-fast and atypical fast-slow forms of the AV nodal re-entrant tachycardia could be induced. Both tachycardias were successfully suppressed with a combination of digoxin and verapamil.

Topics: Adult; Atrioventricular Node; Bundle of His; Cardiac Pacing, Artificial; Digoxin; Dose-Response Relationship, Drug; Electrocardiography; Female; Heart Block; Heart Conduction System; Humans; Tachycardia, Paroxysmal; Verapamil

Topics: Adult; Cesarean Section; Digoxin; Edema; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia, Paroxysmal; Verapamil

Clinical and electrocardiographic findings for 30 patients with the pre-excitation syndrome are described together with details of treatment. Nineteen (63%) were younger than 2 years, 14 of whom were under 2 months. Sixteen infants and 7 children (77%) presented with paroxysmal supraventricular tachycardia, 14 (61%) of whom had the electrocardiographic pattern of type A Wolff-Parkinson-White (WPW) syndrome. During paroxysmal bouts the QRS complex was normal in 21 patients and wide in two. Six (20%) patients had congenital heart disease often associated with WPW syndrome type B. Seventeen patients were treated with either digoxin or verapamil intravenously to stop tachyarrhythmias. Verapamil was more effective due to the immediate response and lack of adverse effects. The tachyarrhythmias resolved in all the patients and in some of them the WPW pattern resolved later indicating maturation of the conduction tissue with loss of the accessory pathways. Verapamil provides a rapid and safe form of treatment for conversion of tachyarrhythmias since it has no effect on the accessory pathways. Oral amiodarone prevents recurrent tachyarrhythmias resistant to other treatment.

Topics: Adolescent; Amiodarone; Child; Child, Preschool; Digoxin; Electrocardiography; Humans; Infant; Infant, Newborn; Tachycardia, Paroxysmal; Verapamil; Wolff-Parkinson-White Syndrome

Paroxysmal supraventricular tachycardia is a common problem in infancy and childhood. Past treatment has included digitalis and nonselective beta blockers (propranolol). We describe a new mode of therapy with a cardioselective beta blocker (metoprolol) that may be of use in patients resistant to standard therapy.

Topics: Bronchial Spasm; Digoxin; Drug Therapy, Combination; Female; Humans; Infant; Metoprolol; Propanolamines; Propranolol; Sleep Wake Disorders; Tachycardia, Paroxysmal

Topics: Adult; Aged; Digoxin; Dose-Response Relationship, Drug; Emergencies; Female; Humans; Injections, Intravenous; Male; Middle Aged; Tachycardia, Paroxysmal

Three cases of perinatal paroxysmal supraventricular tachycardia are described. In two patients the tachycardia was present prior to delivery; in the third baby, who also had the Wolf-Parkinson-White Syndrome, the time of onset of tachycardia is not known. The risks of this condition to the foetus are largely unknown but severe intra-uterine cardiac failure can occur. Possible lines of management are discussed.

Topics: Adult; Digoxin; Female; Humans; Infant, Newborn; Male; Pregnancy; Prenatal Diagnosis; Tachycardia, Paroxysmal

Topics: Digoxin; Female; Humans; Middle Aged; Migraine Disorders; Tachycardia, Paroxysmal

Topics: Adolescent; Adult; Aged; Amiodarone; Benzofurans; Child; Digitalis; Digoxin; Female; Follow-Up Studies; Humans; Male; Medigoxin; Middle Aged; Plants, Medicinal; Plants, Toxic; Tachycardia, Paroxysmal

In clinical Arrhythmology it is often necessary to associate digitalis and antiarrhythmic agents. This calls for study of possible interaction between the employed drugs. We found a statistically significant correlation between digitalis and amiodarone plasma level in patients on long term treatment with both drugs. A statistically significant linear correlation between plasma amiodarone level and digoxin (0.25 mg/day) or beta-methyldigoxin (0.20 mg/day) was documented in 33 patients. 23 patients had been treated with these drugs for paraxysmal reciprocating supraventricular tachycardia since an average of 52 months (computerized follow-up). (Amiodarone average weekly dose was 1078 +/- 168 mg after a loading dose of 12 gm given over one month). 10 patients were on chronic treatment with higher weekly doses of amiodarone (average dose 2380 +/- 731 mg per week). Thyroid function tests (T4; T3; T3UP; TSH; rT3) were checked in every patients. Further studies are warranted to understand the mechanism of the interaction between amiodarone and digitalis. As a clinical implication we point out that amiodarone-digoxin (or betamethyldigoxin) interaction in our patients has neither resulted in over-therapeutic plasma level nor in signs of digitalis toxicity.

Topics: Aged; Amiodarone; Arrhythmias, Cardiac; Benzofurans; Digoxin; Drug Interactions; Female; Humans; Male; Medigoxin; Middle Aged; Tachycardia, Paroxysmal

Results of studies of 15 adults placed on quinidine therapy after their serum digoxin concentrations were stabilized showed significantly increased digoxin concentrations. The average digoxin concentration before quinidine therapy was 0.75 +/- 0.28 ng/mL and after 4 days of quinidine therapy was 1.41 +/- 0.43 ng/mL. During this period, the renal clearance of digoxin decreased from 53.4 +/- 21 mL/min . 1.73 m to 35.3 +/- 12.6 mL/ min . 1.73 m. No significant correlation was found between the individual rise in serum digoxin concentrations and the rise in serum quinidine concentrations. These results suggest that serum digoxin concentration should be monitored closely for at least the first 4 days of quinidine therapy.

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Heart Failure; Heart Ventricles; Humans; Middle Aged; Prospective Studies; Quinidine; Tachycardia, Paroxysmal

The clinical and electrophysiologic features of eight patients with unusually rapid, medically refractory paroxysmal supraventricular tachycardia are described. Exercise induction of tachycardia and functional bundle branch block patterns during tachycardia were common. Tachycardia resulted from anterograde enhanced atrioventricular nodal conduction combined with retrograde conduction by a concealed left atrial-left ventricular accessory pathway producing rates ranging from 200 to 300 beats/min. Management and late follow-up study were characterized by generally unsuccessful electrophysiologic-pharmacologic testing and inconsistent rhythm control with continued drug therapy. Three patients underwent successful surgical interruption of the concealed accessory pathway, with elimination of recurrent tachycardias. These patients represent a unique subgroup with an identifiable electrophysiologic basis for unusually rapid tachycardias, potentially benefiting from invasive study and aggressive therapy.

Topics: Adolescent; Adult; Atrioventricular Node; Bundle-Branch Block; Digoxin; Electrophysiology; Female; Follow-Up Studies; Heart Conduction System; Humans; Male; Quinidine; Tachycardia, Paroxysmal

The case of a 73-year-old woman with frequent disabling attacks of supraventricular tachycardia refractory to pharmacological therapy is presented. Successful management was achieved with a radio-frequency-activated pacemaker.

Topics: Aged; Digoxin; Electrophysiology; Female; Humans; Pacemaker, Artificial; Propranolol; Radio Waves; Tachycardia, Paroxysmal

A patient with fetal paroxysmal supraventricular tachycardia (PST) with a heart rate above 300 beats/minute in the 29th week of pregnancy is described. The fetus showed signs of severe cardiac failure and was, therefore, digitalized by giving the mother 0.5 mg digoxin intravenously on the first day and the 0.25 mg oral digoxin daily throughout the pregnancy. After one day a normal rhythm was observed. The patient was delivered of a healthy girl after 38 weeks of pregnancy. Digoxin concentrations in samples of umbilical cord vein and artery, intrapartum scalp capillary, and amniotic fluid were almost equal, but somewhat lower than in simultaneously obtained maternal serum. Intrauterine digoxin treatment of fetuses with PST is discussed.

Topics: Adult; Digoxin; Female; Fetal Diseases; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Tachycardia, Paroxysmal

Serial electrophysiologic testing of multiple drugs was performed in 21 patients with recurrent atrioventricular (AV) nodal reentrant paroxysmal supraventricular tachycardia (PSVT). All patients had reproducible sustained PSVT induced before drug administration. Serial daily PSVT induction was attempted after administration of i.v. ouabain (0.01 mg/kg) (16 patients), i.v. propranolol (0.1 mg/kg (17 patients), i.v. ouabain + propranolol (same dosages) (12 patients), i.v. procainamide (600-1000 mg) (17 patients) and oral quinidine (1600-2400 mg/day) (nine patients). In two of 21 patients (10%), no tested drug prevented induction of sustained PSVT. In 19 of 21 patients (90%), one or more drugs prevented induction of sustained PSVT: ouabain--seven patients, propranolol--seven patients, ouabain + propranolol--seven patients, procainamide--11 patients, quinidine--seven patients. The site of action of ouabain and/or propranolol was either the antegrade limb or the retrograde limb (RL) of the circus movement. The site of action of procainamide or quinidine was always the RL. These 19 patients were treated with oral drugs, based on results of serial testing. Eighteen patients were successfully followed for 6-50 months. In 13 of these 18 patients PSVT did not recur. Two patients (11%) had > 95% reduction in frequency of PSVT recurrences, and three (17%) did not respond to chosen oral drugs. Serial electrophysiologic testing of multiple drugs is feasible in patients with AV nodal reentrant paroxysmal tachycardia. Drug responses are variable. In most but not all patients, serial electrophysiologic testing defines effective prophylactic drug therapy. This method of defining prophylactic drug therapy appears most suitable for patients with poorly tolerated tachycardias that occur only sporadically.

Topics: Administration, Oral; Adult; Aged; Atrioventricular Node; Digoxin; Drug Therapy, Combination; Electrophysiology; Female; Heart Conduction System; Humans; Injections, Intravenous; Male; Middle Aged; Ouabain; Pharmaceutical Preparations; Procainamide; Propranolol; Quinidine; Tachycardia, Paroxysmal

This report describes a clinical syndrome of arrhythmias that may have neural origin. Two patients presented with episodes of loss of consciousness, disorientation, and paroxysmal supraventricular tachycardia (PSVT). One patient reported experiencing neurologic symptoms without tachycardia. When electrophysiologic testing with intracardiac recordings and programmed stimulation yielded no abnormalities that could account for the arrhythmias, a primary neurologic abnormality was sought. The electroencephalograms of both patients showed epileptiform discharges that supported this hypothesis. Arrhythmias and neurologic symptoms were controlled by treatment with the antiepileptic drug carbamazepine in one patient. Findings in these two patients suggest that in some patients arrhythmias may be a manifestation of seizures.

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Carbamazepine; Digoxin; Electroencephalography; Electrophysiology; Epilepsy; Humans; Male; Phenytoin; Tachycardia, Paroxysmal

Topics: Adrenergic beta-Antagonists; Ajmaline; Amiodarone; Anti-Arrhythmia Agents; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiac Pacing, Artificial; Digoxin; Disopyramide; Electric Countershock; Humans; Phenytoin; Procainamide; Quinidine; Tachycardia; Tachycardia, Paroxysmal; Verapamil

The digitalis derivative beta-methyldigoxin has been shown to be quickly and well absorbed from the gut and, in hemodynamic studies, to start acting rapidly after intravenous administration. However, when tested on 6 patients suffering from paroxysmal reciprocating atrioventricular tachycardia, or having an accessory pathway who might develop this disorder, there was no effect on induced tachycardias or on AV conduction during rapid atrial pacing or the extrastimulus test. One of the 6 patients showed some increase in refractoriness of conduction through the AV node within 25 min after the injection. Beta-methyldigoxin does not appear to be a satisfactory alternative to other effective agents available for the prompt correction of paroxysmal reciprocating atrioventricular tachycardia.

Topics: Adolescent; Adult; Cardiac Pacing, Artificial; Digoxin; Electrocardiography; Electrophysiology; Heart Conduction System; Humans; Male; Medigoxin; Middle Aged; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

A newborn baby shows atrial tachycardia and gets into cardiac failure by atrial fibrillation at 12 weeks of age. With digoxin and chinidin spontaneous conversion to multifocal atrial tachycardia occurs. Treatment with additional propranolol leads to atrial fibrillation and paroxysmal atrial tachycardia with block. When chinidin was discontinued atrial flutter occurred. With a maintenance therapy with digoxin and chinidin the baby remained asymptomatic, and sinusrhythm occurred at 6 months of age. At 9 months chinidin was discontinued. At 14 months of age, the child is well and in sinusrhythm with a maintenance digoxin therapy. This seems to be the third described case of multifocal atrial tachycardia in infancy.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Electrocardiography; Heart Rate; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Propranolol; Quinidine; Tachycardia; Tachycardia, Paroxysmal

Topics: Adult; Digoxin; Female; Fetus; Humans; Infant, Newborn; Maternal-Fetal Exchange; Milk, Human; Pregnancy; Pregnancy Complications, Cardiovascular; Tachycardia, Paroxysmal

23 cases of paroxysmal tachycardia in infancy and childhood (22 cases of supraventricular and 1 case of ventricular paroxysmal tachycardia) are reported. Clinical problems of 13 infants aged 1 day to 6 months are compared with those of 10 children and discussed. A primary disease e.g. congenital heart disease, myocarditis was observed in 8 cases and WPW-syndrome in 4 cases. Owing to the threatening cardiac failure especially in infancy a special attention should be taken to the immediately diagnosis. Treatment and prevention are discussed.

Topics: Child; Child, Preschool; Digoxin; Electrocardiography; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Radiography; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Adolescent; Asthma; Digoxin; Humans; Male; Propranolol; Tachycardia, Paroxysmal

A family had an unusual and perhaps unique familial dysrhythmia. The proband had a short PR interval with normal QRS and chronic recurrent paroxysmal atrial tachycardia (Lown-Ganong-Levine syndrome). The arrhythmia produced left ventricular dysfunction. Both paroxysmal atrial tachycardia (PAT) and left ventricular dysfunction were reversed with administration of digoxin and propranolol hydrochloride. Three family members had paroxysmal or chronic atrial fibrillation, first diagnosed at a relatively young age (23 years, 38 years, and early 40s, respectively). Five additional family members had short PR intervals with normal QRS, and eight other family members had borderline short PR intervals. The mode of inheritance appeared to be autosomal dominant with varying expressivity. We have described a familial syndrome characterized by PAT or atrial fibrillation in its advanced form with short PR interval as a possible identifying trait. The future course of members with isolated short PR is unknown.

Topics: Adult; Arrhythmias, Cardiac; Digoxin; Electrocardiography; Female; Heart Atria; Humans; Male; Pedigree; Propranolol; Syndrome; Tachycardia, Paroxysmal

Topics: Adolescent; Adult; Anti-Arrhythmia Agents; Aprindine; Atrioventricular Node; Bundle of His; Cardiac Pacing, Artificial; Child; Digoxin; Disopyramide; Drug Therapy, Combination; Electrocardiography; Female; Follow-Up Studies; Heart Conduction System; Humans; Male; Middle Aged; Ouabain; Procainamide; Propranolol; Tachycardia, Paroxysmal

Patient-controlled rapid atrial pacing was used to manage 12 cases of recurrent supraventricular tachycardia refractory to drug therapy. The pacing system consists of an implanted receiver-lead system and an external patient-activated transmitter. In each case, brief periods (5 to 20 seconds) of rapid atrial pacing were effective in terminating the supraventricular tachycardia and resulted in a return to normal sinus rhythm. In three patients, occasional transient episodes of atrial flutter or atrial fibrillation preceded a spontaneous return to normal sinus rhythm. The pacing system was removed in one patient 13 months postoperatively because of persistent pericarditis; one patient died of an unrelated cerebral hemorrhage 13 months postoperatively. Successful management of supraventricular tachycardia has been maintained in the 10 remaining patients for 15 to 36 months (average 26.4). In more than 6,000 patient applications of rapid atrial pacing, there has been only one failure to convert the tachycardia. Successful application of permanent rapid atrial pacing requires (1) prescreening of patients with temporary external rapid atrial pacing to verify susceptibility to conversion of supraventricular tachycardia and absence of anomalous conduction pathways that may permit conduction of rapid pacing rates to the ventricles, and (2) assessment of the patient's ability to use the transmitter properly.

Topics: Adult; Aged; Atrial Fibrillation; Digoxin; Heart Rate; Humans; Male; Middle Aged; Pacemaker, Artificial; Procainamide; Propranolol; Recurrence; Self-Help Devices; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Ten infants who had paroxysmal atrial tachycardia in utero or at birth are reported. Because of apparent fetal distress, caesarean section was performed in 4 cases and labour was induced in 1. Birthweight was generally large for gestational age. Severe ascites and hydrops at birth were manifestations of cardiac failure. Atrial flutter was recorded in 4 infants and supraventricular tachycardia in 5. The WoLff-Parkinson-White syndrome became evident later in 2. Digoxin was given to all 10 infants, and cardioversion was required and was effective in 4. Known recurrences in childhood have occurred in only 1 patient. Congenital atrial tachyarrhythmias may be commoner than generally believed, and fetal electrocardiography may help to avoid unnecessary termination of pregnancy. Blood sugar determinations are important, since neonatal hypoglycaemia was found. Cardioversion should be performed promptly in severely ill infants or if there is no response to digoxin. Care is required to avoid digoxin toxicity.

Topics: Birth Weight; Digoxin; Female; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Tachycardia, Paroxysmal

Evaluation of a patient with tachycardia upon swallowing offers evidence of its origin from the left atrium. The tachycardia appears to arise from an automatic focus discharged after mechanical stimulation by the esophagus. Despite a left atrial origin for this arrhythmia, it does not fulfull previously described electrocardiographc criteria for "left atrial rhythms."

Topics: Action Potentials; Atrial Flutter; Bundle of His; Deglutition; Digoxin; Electrocardiography; Humans; Male; Middle Aged; Propranolol; Refractory Period, Electrophysiological; Tachycardia, Paroxysmal

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: Digoxin; Humans; Infant, Newborn; Male; Tachycardia, Paroxysmal

A critically ill infant with paroxysmal supraventricular tachycardia and hydrops fetalis responded well to aggressive management. Care must be taken to avoid digitalis toxicity. Procaine amide or quinidine are effective alternate therapies.

Topics: Digoxin; Edema; Electrocardiography; Female; Fetal Diseases; Furosemide; Heart Ventricles; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Positive-Pressure Respiration; Pregnancy; Procainamide; Tachycardia, Paroxysmal; Water

Topics: Child; Child, Preschool; Digoxin; Drug Evaluation; Heart Defects, Congenital; Heart Failure; Humans; Infant; Pneumonia; Sepsis; Tachycardia, Paroxysmal

Atrioventricular (A-V) conduction, ventriculo-atrial conduction and mechanism of tachycardia were studied by programmed electrical stimulation before and after the administration of ouabain in 15 patients suffering from paroxysmal supraventricular re-entrant tachycardia. In 13 patients the tachycardia circuit was confined to the A-V node. In two patients the stimulation study showed that an accessory pathway was used in a ventriculo-atrial direction during tachycardia. Ouabain lengthened the effective and functional refractory period of the A-V node and A-V nodal transmission time in all patients in whom this could be studied. Only six patients showed lengthening in ventriculo-atrial conduction time or refractory period of the ventriculo-atrial conduction system. In seven patients no tachycardia could be initiated after ouabain. The width of the zone of atrial premature beats able to initiate tachycardia (the tachycardia zone) narrowed in five patients, showed no change in two patients, and increased in one patient. In these eight patients the tachycardia zone shifted to longer premature beat intervals. Ouabain resulted in slowing of cardiac rate during tachycardia. Both patients who used an accessory pathway during tachycardia showed no change in width of their tachycardia zone following ouabain administration. Seven patients were restudied two weeks after chronic oral administration of digoxin. The results were similar to those obtained following ouabain administration. This indicates that in patients suffering from paroxysmal A-V nodal tachycardia the effect of chronic oral digoxin administration can be predicted from the study of the effect of ouabain during programmed stimulation of the heart.

Topics: Adolescent; Adult; Aged; Atrioventricular Node; Child; Digitalis Glycosides; Digoxin; Electric Stimulation; Electrocardiography; Female; Humans; Male; Middle Aged; Ouabain; Tachycardia, Paroxysmal

Topics: Atrial Fibrillation; Atrial Flutter; Atrioventricular Node; Child; Congenital Abnormalities; Delivery, Obstetric; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Infant; Infant, Newborn; Male; Pregnancy; Propranolol; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Adult; Digoxin; Electrocardiography; Heart Block; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Male; Radiography; Rheumatic Fever; Tachycardia, Paroxysmal; Time Factors

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: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Blood Pressure; Bradycardia; Digoxin; Electrocardiography; Female; Heart Ventricles; Humans; Injections, Intravenous; Male; Methyldopa; Middle Aged; Syndrome; Tachycardia; Tachycardia, Paroxysmal; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Adult; Aged; Bundle of His; Bundle-Branch Block; Digoxin; Electrocardiography; Female; Heart Block; Heart Conduction System; Humans; Male; Middle Aged; Sinoatrial Node; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Angiocardiography; Atrial Flutter; Cardiac Complexes, Premature; Digoxin; Electrocardiography; Heart Aneurysm; Heart Failure; Heart Injuries; Heart Ventricles; Myocardial Infarction; Propranolol; Quinidine; Tachycardia, Paroxysmal

Topics: Adolescent; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Humans; Male; Physical Exertion; Propranolol; Tachycardia; Tachycardia, Paroxysmal

Topics: Administration, Oral; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digoxin; Electrocardiography; Heart Failure; Humans; Injections, Intravenous; Monitoring, Physiologic; Myocardial Infarction; Ouabain; Tachycardia, Paroxysmal

Topics: Cardiomyopathies; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Follow-Up Studies; Humans; Infant; Male; Myocarditis; Procainamide; Prognosis; Propranolol; Quinidine; Recurrence; Tachycardia, Paroxysmal; Time Factors; Ventricular Fibrillation

Topics: Child; Child, Preschool; Digoxin; Humans; Infant; Infant, Newborn; Male; Procainamide; Quinidine; Tachycardia, Paroxysmal

Topics: Arrhythmias, Cardiac; Birth Injuries; Clavicle; Digoxin; Electrocardiography; Fractures, Bone; Humans; Infant, Newborn; Obstetrical Forceps; Tachycardia, Paroxysmal

Topics: Ajmaline; Apgar Score; Arrhythmias, Cardiac; Cesarean Section; Digoxin; Electrocardiography; Extraction, Obstetrical; Female; Fetus; Heart Block; Humans; Infant; Infant, Newborn; Lanatosides; Pregnancy; Prenatal Diagnosis; Tachycardia; Tachycardia, Paroxysmal; Ventricular Fibrillation; Verapamil; Wolff-Parkinson-White Syndrome

Topics: Anemia; Anti-Bacterial Agents; Cardiomyopathies; Diet, Sodium-Restricted; Digoxin; Diuretics; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Myocarditis; Palliative Care; Respiratory Tract Infections; Rest; Tachycardia, Paroxysmal

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Female; Heart Rate; Humans; Male; Middle Aged; Pindolol; Tachycardia; Tachycardia, Paroxysmal

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Catheterization; Digoxin; Electrocardiography; Female; Heart Rate; Humans; Male; Methods; Middle Aged; Phenytoin; Procainamide; Propranolol; Quinidine; Tachycardia, Paroxysmal; Time Factors; Wolff-Parkinson-White Syndrome

Topics: Adult; Aged; Aortic Valve; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Blood Urea Nitrogen; Digoxin; Female; Heart Block; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Prospective Studies; Tachycardia, Paroxysmal; Tricuspid Valve; Ventricular Fibrillation

Topics: Child; Child, Preschool; Digoxin; Electric Countershock; Electrocardiography; Humans; Infant; Lidocaine; Pacemaker, Artificial; Posture; Procainamide; Propranolol; Tachycardia, Paroxysmal; Valsalva Maneuver; Verapamil

Topics: Adolescent; Age Factors; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Heart Defects, Congenital; Heart Ventricles; Humans; Infant; Infant, Newborn; Infections; Male; Methods; Myocarditis; Quinidine; Sulfates; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Acidosis; Digitalis Glycosides; Digoxin; Electric Countershock; Electrocardiography; Female; Heart Block; Humans; Hypokalemia; Infant, Newborn; Infant, Newborn, Diseases; Male; Tachycardia, Paroxysmal

Topics: Ajmaline; Digoxin; Electrocardiography; Furosemide; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Phytotherapy; Plants, Medicinal; Potassium; Rauwolfia; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Angina Pectoris; Atrial Fibrillation; Bradycardia; Cardiac Catheterization; Diagnosis, Differential; Diagnostic Errors; Digoxin; Electrocardiography; Humans; Hyperthyroidism; Lidocaine; Male; Middle Aged; Myocardial Infarction; Procainamide; Tachycardia; Tachycardia, Paroxysmal; Thyroxine

Topics: Accidents; Adolescent; Adult; Aged; Cardiac Complexes, Premature; Child, Preschool; Coronary Disease; Digoxin; Female; Half-Life; Humans; Male; Middle Aged; Poisoning; Radioimmunoassay; Suicide; Tachycardia, Paroxysmal; Ventricular Fibrillation

Topics: Adolescent; Adult; Digoxin; Female; Heart Block; Humans; Male; Middle Aged; Tachycardia, Paroxysmal

Topics: Adult; Atrial Fibrillation; Digoxin; Heart Atria; Heart Block; Humans; Male; Myocarditis; Pacemaker, Artificial; Physical Exertion; Propranolol; Radio Waves; Remission, Spontaneous; Tachycardia; Tachycardia, Paroxysmal

Topics: Digoxin; Female; Humans; Metaraminol; Middle Aged; Pacemaker, Artificial; Propranolol; Quinidine; Tachycardia, Paroxysmal; Thyroid Hormones

Topics: Atropine; Blood Pressure; Cardiac Catheterization; Cardiac Volume; Child, Preschool; Cyanosis; Digoxin; Female; Heart Rate; Humans; Infant; Oxygen; Pacemaker, Artificial; Propranolol; Pulmonary Circulation; Respiration; Tachycardia, Paroxysmal; Tetralogy of Fallot

Topics: Anti-Bacterial Agents; Anticoagulants; Aortic Coarctation; Bradycardia; Chlorothiazide; Diet, Sodium-Restricted; Digitalis Glycosides; Digitoxin; Digoxin; Drug Tolerance; Electrocardiography; Endocardial Fibroelastosis; Furosemide; Heart Block; Heart Defects, Congenital; Heart Failure; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Lanatosides; Myocarditis; Organomercury Compounds; Oxygen Inhalation Therapy; Potassium Chloride; Pulmonary Edema; Tachycardia; Tachycardia, Paroxysmal; Transposition of Great Vessels

Topics: Digoxin; Electrocardiography; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Tachycardia, Paroxysmal

Topics: Cesarean Section; Child; Digoxin; Electrocardiography; Female; Fetal Diseases; Fetal Heart; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Pregnancy; Tachycardia, Paroxysmal

Topics: Adult; Aged; Atrial Fibrillation; Atrial Flutter; Digitalis Glycosides; Digoxin; Electrocardiography; Heart Block; Humans; Male; Tachycardia, Paroxysmal

Topics: Absorption; Cardiac Glycosides; Digoxin; Electrocardiography; Heart Failure; Humans; Tachycardia, Paroxysmal; Time Factors

Topics: Adult; Cholecystectomy; Digoxin; Electric Countershock; Electrocardiography; Female; Heart Failure; Humans; Male; Metaraminol; Middle Aged; Myocardial Infarction; Quinidine; Tachycardia, Paroxysmal

Topics: Digitalis Glycosides; Digoxin; Heart Block; Humans; Infant; Quinidine; Tachycardia, Paroxysmal

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Coronary Disease; Digoxin; Female; Heart Defects, Congenital; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia, Paroxysmal

Topics: Anti-Bacterial Agents; Digoxin; Electrocardiography; Enterovirus B, Human; Humans; Infant; Male; Tachycardia, Paroxysmal; Virus Diseases

Topics: Atropine; Digoxin; Electrocardiography; Female; Heart Block; Heart Rate; Humans; Reserpine; Tachycardia, Paroxysmal

Topics: Atrial Fibrillation; Chronic Disease; Digoxin; Electrocardiography; Heart Ventricles; Humans; Hydrochlorothiazide; Male; Middle Aged; Pacemaker, Artificial; Phenytoin; Procainamide; Propranolol; Quinidine; Tachycardia, Paroxysmal

Topics: Blood Pressure; Coronary Disease; Digoxin; Heart Diseases; Heart Rate; Humans; Hypertension; Intestinal Absorption; Pulmonary Heart Disease; Pulse; Tablets; Tachycardia, Paroxysmal

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

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Child; Child, Preschool; Digitalis Glycosides; Digoxin; Female; Heart Block; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Middle Aged; Potassium; Pulmonary Heart Disease; Tachycardia; Tachycardia, Paroxysmal

Topics: Digoxin; Drug Therapy; Electrocardiography; Heart Block; Heart Conduction System; Humans; Myocardial Infarction; Quinidine; Reserpine; Tachycardia; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome

Topics: Diagnosis, Differential; Digitalis; Digitalis Glycosides; Digoxin; Drug Therapy; Electrocardiography; Humans; Tachycardia; Tachycardia, Paroxysmal; Toxicology