digoxin and Tachycardia

Atrial flutter (AFL) in pediatric patients is a rare condition as the physical dimensions of the immature heart are inadequate to support the arrhythmia. This low incidence makes it difficult for patients in this particular setting to be studied. AFL accounts for 30% of fetal tachyarrhythmias, 11% to 18% of neonatal tachyarrhythmias, and 8% of supraventricular tachyarrhythmias in children older than 1 year of age. Transesophageal overdrive pacing can be used, instead, with lower success rate (60%-70%). The recommended drugs are digoxin which can decrease the ventricular rate until the spontaneous interruption of the AFL. Digoxin can be combined with flecainide or amiodarone in case of failure.

Topics: Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Flutter; Child; Child, Preschool; Digoxin; Flecainide; Humans; Infant, Newborn; Tachycardia

The aim of this study is to evaluate the prevalence of maternal complications derived from digoxin treatment and its relationship with digoxinemia, as well as its occurrence in relation to the different treatment doses and therapeutic schemes used.. This is a retrospective observational study of women who received digoxin for the treatment of fetal tachyarrhythmia over a 10-year period at the University Hospital Virgen del Rocío (Seville). Data corresponding to the digoxin dose, its duration, serum digoxin levels and electrocardiographic parameters during follow-up were collected. Maternal side effects were reported, and its relationship to the treatment dose as well as digoxinemia. The study is accompanied by a narrative review of related literature.. There were 10 cases eligible. During treatment, as least one symptom or sign was present in 30 % of cases, being in all cases digestive symptoms. In all those cases, the digoxin level was higher than established as therapeutic threshold (2 ng/mL), and all reversed within a maximum of 48 h after the dose decrease. Digoxinemia overdosing (> 2 ng/mL) was observed in 6 women (60 %), one of which reached the toxicity range (> 3 ng/mL). In all cases, normal range was achieved decreasing the dose of digoxin 0.25 mg every 24 h. No patient developed side effects with digoxinemia below 2 ng/mL. No electrocardiographic abnormalities appeared during treatment.. Digoxin is a safe treatment for management of fetal tachyarrhythmias. Side effects appear frequently when serum digoxin level is over 2 ng/mL, but they are usually mild and self-limited. However, it remains advisable to monitor electrocardiographic changes and digoxinemia through the whole therapy to prevent serious complications related to digoxin toxicity.

Topics: Digoxin; Electrocardiography; Female; Humans; Maternal Inheritance; Observational Studies as Topic; Retrospective Studies; Tachycardia

Since 1953, sinus tachycardia has been defined as a heart rate (HR) in sinus rhythm of >100 beats per minute (bpm). However, this number has never been formally evaluated, and no established threshold values for special groups, such as those with heart failure (HF) accompanied by a reduced ejection fraction (HFrEF). Herein, we provided evidence that lowering the HR of patients with HFrEF to <70 bpm with medications such as ivabradine improves outcomes. Numerous large-scale trials and smaller clinical studies have shown that reducing the HR in patients with HFrEF improves cardiovascular and overall outcomes. Evidence suggests that a HR of <70 bpm is appropriate for patients with HFrEF. Examination of HF registries indicates that in a large proportion of these patients the HR exceeds 80 bpm, and no consideration is given to lowering the HR, due in large part to lack of physician awareness of the benefits of a lower HR. Evidence indicates that the first-line medication for lowering HR in patients with HFrEF is ivabradine. In conclusion, the improved prognosis following appropriate HR management in patients with HFrEF suggest that the cut-off value for sinus tachycardia in these patients should be redefined as 75 bpm. Maintaining a HR of <70 bpm in patients with HFrEF is associated with improved cardiovascular and overall outcomes.

Topics: Cardiovascular Agents; Digoxin; Heart Failure; Heart Rate; Humans; Ivabradine; Stroke Volume; Tachycardia

Takotsubo cardiomyopathy (TC) is characterized by transient wall motion abnormalities most commonly involving the left ventricle (LV). Although biventricular TC had been considered uncommon condition, recently biventricular TC has been reported as a new variant observed in 19-42% of all TC presentations. Since biventricular TC has a poor prognosis as compared with isolated TC, it is important to distinguish between isolated LV TC and biventricular TC. We present a case of 70-year-old female with dyspnea persisting for 2 days. Electrocardiogram showed symmetrical T-wave inversion in leads V2-V4. Transthoracic echocardiography (TTE) revealed diffuse hypo-kinesis except for the apical inferior LV and LV ejection fraction of 32%. Hyper-kinesis of the right ventricular (RV) basal segment and dys-kinesis of the RV apical segment. 2 weeks after admission, coronary angiography showed no evidence of significant stenosis. LV ejection fraction improved to 51% and wall motion abnormalities of the RV basal and apical segments were ameliorated to normo-kinesis. Electrocardiogram revealed symmetrical and deepened T-wave inversion in leads V2-V3. The presence of a transient abnormality in biventricular wall motion beyond a single coronary artery perfusion territory with new electrocardiographic change met the diagnostic criteria of definite TC defined by Mayo Clinic criteria. 4 weeks after admission, no recurrence of wall motion abnormalities in both ventricles were found and T-wave inversion ameliorated. To our knowledge, this is the first report of biventricular TC with asymmetrical abnormities of wall motion between LV and RV.

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin II Type 1 Receptor Blockers; Anti-Arrhythmia Agents; Atrial Fibrillation; Coronary Angiography; Digoxin; Diuretics; Echocardiography; Electrocardiography; Female; Heart Failure; Humans; Tachycardia; Takotsubo Cardiomyopathy; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right

Multiple transplacental medications can be used to treat fetal tachycardia. We sought to perform a systematic review and meta-analysis to determine whether digoxin, flecainide, or sotalol was the most efficacious therapy for converting fetal tachycardia to sinus rhythm.. We performed a systematic review and meta-analysis to compare digoxin, flecainide, or sotalol as first-line therapy for fetal tachycardia. Studies were identified by a search of PubMed (Medline), Web of Science, and Scopus.. Digoxin should not be first-line therapy for fetal tachycardia, particularly in the presence of hydrops fetalis. Flecainide should be the first-line therapy of choice in atrioventricular reentrant tachycardia. Further study may identify further sub-populations responding differently.

Topics: Anti-Arrhythmia Agents; Digoxin; Female; Fetal Diseases; Fetal Therapies; Flecainide; Humans; Pregnancy; Sotalol; Tachycardia

Digoxin has been a key therapeutic for heart failure and atrial tachyarrhythmias for over 200 years following Withering's groundbreaking work depicting the therapeutic benefit of the common botanical foxglove in his 1785 monograph. The use of digoxin preceded any randomised evidence or even basic understanding of its mechanism of action. Over the past two decades, there has been mounting evidence further challenging the safety and efficacy of digoxin, while multiple other therapies for both heart failure and atrial tachyarrhythmias have proven to be more effective and safe. Altogether, digoxin still has an important role in contemporary pharmacotherapeutics, though its role remains controversial and should be reserved for selective patients and clinical situations, with careful attention to serum concentrations.

Topics: Cardiotonic Agents; Digoxin; Drug Interactions; Evidence-Based Medicine; Heart Failure; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; Humans; Retrospective Studies; Tachycardia; Treatment Outcome

Heart failure remains a major health problem in the United States, affecting 5.8 million Americans. Its prevalence continues to rise due to the improved survival of patients. Despite advances in treatment, morbidity and mortality remain very high, with a median survival of about 5 years after the first clinical symptoms. This article describes the causes, classification, and management goals of heart failure in Stages A and B.

Topics: Adrenergic beta-Antagonists; Alcohol Drinking; Angiotensin-Converting Enzyme Inhibitors; Cardiac Pacing, Artificial; Cardiotonic Agents; Cardiotoxins; Coronary Artery Disease; Defibrillators, Implantable; Diabetic Cardiomyopathies; Digoxin; Dyslipidemias; Early Diagnosis; Endocrine System Diseases; Heart Failure; HIV Infections; Humans; Hypertension; Metabolic Syndrome; Mineralocorticoid Receptor Antagonists; Renal Insufficiency, Chronic; Risk Factors; Sedentary Behavior; Sleep Apnea Syndromes; Smoking; Tachycardia

The present review will examine the prognostic importance of atrial fibrillation and heart failure, explore the different therapeutic options for treating atrial fibrillation and present the results of the Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial.. The Atrial Fibrillation and Congestive Heart Failure trial was a randomized trial involving patients with both atrial fibrillation and heart failure. The trial was designed to compare the maintenance of sinus rhythm with the control of ventricular rate in patients with left ventricular dysfunction, heart failure and a history of atrial fibrillation. There was no significant difference in the rate of death from cardiovascular causes in the rhythm-control group as compared with the rate-control strategy. In addition, there was no significant difference in any of the secondary outcomes including death from any cause, worsening heart failure or stroke. The rate-control strategy eliminated the need for repeated cardioversion and reduced rates of hospitalization.. The results of the Atrial Fibrillation and Congestive Heart Failure trial indicate that a routine strategy of rhythm control does not reduce rate of death and suggest that rate control should be considered a primary approach for patients with atrial fibrillation and heart failure.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Cardiomyopathies; Catheter Ablation; Comorbidity; Digoxin; Heart Failure; Heart Rate; Humans; Randomized Controlled Trials as Topic; Tachycardia

The pharmacological treatment of fetal tachycardia (FT) has been described in various publications. We present a study reviewing the necessity for treatment of FT, the regimens of drugs used in the last two decades and their mode of administration. The absence of reliable predictors of fetal hydrops (FH) has led most centers to initiate treatment as soon as the diagnosis of FT has been established, although a small minority advocate nonintervention. As the primary form of pharmacological intervention, oral maternal transplacental therapy is generally preferred. Digoxin is the most common drug used to treat FT; however, effectiveness remains a point of discussion. After digoxin, sotalol seems to be the most promising agent, specifically in atrial flutter and nonhydropic supraventricular tachycardia (SVT). Flecainide is a very effective drug in the treatment of fetal SVT, although concerns about possible pro-arrhythmic effects have limited its use. Amiodarone has been described favorably, but is frequently excluded due to its poor tolerability. Verapamil is contraindicated as it may increase mortality. Conclusions on other less frequently used drugs cannot be drawn. In severely hydropic fetuses and/or therapy-resistant FT, direct fetal therapy is sometimes initiated. To minimize the number of invasive procedures, fetal intramuscular or intraperitoneal injections that provide a more sustained release are preferred. Based on these data we propose a drug protocol of sotalol 160 mg twice daily orally, increased to a maximum of 480 mg daily. Whenever sinus rhythm is not achieved, the addition of digoxin 0.25 mg three times daily is recommended, increased to a maximum of 0.5 mg three times daily. Only in SVT complicated by FH, either maternal digoxin 1 to 2mg IV in 24 hours, and subsequently 0.5 to 1 mg/day IV, or flecainide 200 to 400 mg/day orally is proposed. Initiating direct fetal therapy may follow failure of transplacental therapy.

Topics: Anti-Arrhythmia Agents; Clinical Trials as Topic; Digoxin; Female; Fetal Distress; Humans; Pregnancy; Sotalol; Tachycardia

Sustained fetal tachyarrhythmia (> 180 bpm) is a potentially life-threatening condition for the unborn. Digoxin is commonly used as an initial monotherapy. Flecainide, sotalol, and verapamil are also used as a monotherapy or a combination therapy with digoxin. The treatment success rate with digoxin is about 50%. Presence of hydrops is associated with poor placental transfer of digoxin. Although transplacental pharmacotherapy has been available, it is a challenging task to maximize fetal drug exposure, while minimizing drug exposure of the mother. In addition, clear evidence behind drug of choice and treatment algorithm is lacking. Whereas prospective clinical studies with rigorous design remain to be seen, our knowledge on placental drug transport at a molecular level has been steadily increasing. For example, an ATP-dependent membrane protein, known as P-glycoprotein, is expressed in placenta, decreasing fetal exposure to maternal digoxin. Pharmacological manipulation of drug transporters may open a door to ultimate optimization of the transplacental pharmacotherapy.

Topics: Anti-Arrhythmia Agents; ATP Binding Cassette Transporter, Subfamily B, Member 1; Carrier Proteins; Digoxin; Female; Fetal Diseases; Humans; Maternal-Fetal Exchange; Placenta; Pregnancy; Tachycardia

Topics: Anti-Arrhythmia Agents; Aortic Valve Stenosis; Digoxin; Echocardiography; Echocardiography, Doppler, Color; Female; Fetal Heart; Gestational Age; Heart Block; Heart Defects, Congenital; Humans; Pregnancy; Tachycardia; Ultrasonography, Prenatal

Topics: Adrenergic beta-Antagonists; Atrial Fibrillation; Calcium Channel Blockers; Catheter Ablation; Digoxin; Heart Rate; Humans; Tachycardia

A case of nonimmune hydrops fetalis (NIHF) secondary to fetal supraventricular tachycardia (SVT) diagnosed at 33 weeks gestation is presented. Administration of digoxin to the mother yielded normal fetal heart rhythm and frequency as well as progressive resolution of hydrops after 24 hours of initiation of therapy. Causes of NIHF and diagnostic approach are mentioned. Diagnosis and management of fetal arrhythmias are discussed. The successful perinatal outcome obtained in this case and the literature review, recommend the use of antiarrhythmic drugs therapy in cases of NIHF secondary to SVT.

Topics: Adult; Digoxin; Female; Humans; Hydrops Fetalis; Polyhydramnios; Pregnancy; Prenatal Care; Prenatal Diagnosis; Tachycardia

Topics: Amiodarone; Benzofurans; Digoxin; Drug Interactions; Humans; Kinetics; Quinidine; Tachycardia

Topics: Anti-Arrhythmia Agents; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Cardiac Pacing, Artificial; Child; Child, Preschool; Digoxin; Electrocardiography; Electrophysiology; Heart Block; Humans; Infant; Mitral Valve Prolapse; Pacemaker, Artificial; Tachycardia

Topics: Acebutolol; Adolescent; Adrenergic beta-Antagonists; Adult; Aged; Amiodarone; Anti-Arrhythmia Agents; Child; Computers; Digoxin; Humans; Medigoxin; Middle Aged; Oxprenolol; Propafenone; Propiophenones; Sotalol; Tachycardia; Verapamil

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: Acid-Base Imbalance; Aged; Atropine; Cardiac Complexes, Premature; Digitalis Glycosides; Digitoxin; Digoxin; Drug Interactions; Heart Block; Heart Failure; Heart Ventricles; Humans; Kidney Failure, Chronic; Phenytoin; Potassium; Tachycardia

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

Antibodies to digitalis glycosides have been elicited in experimental animals and have been utilized in the development of rapid, sensitive, specific and convenient radioimmunoassay methods for the clinical measurement of digoxin and other cardiac glycosides in man. The use of these assay methods has supplemented earlier studies with radiolabeled digitalis preparations and has made it possible to obtain much new information concerning factors which may contribute to the well known patient to patient variability in digitalis dosage requirements and in sensitivity to the toxic effects of cardiac glycosides. In some patients with a poor clinical response to digitalis, the finding of a serum concentration which is relatively low for the dose prescribed may suggest that true digitalis resistance is not present and may raise questions of poor patient compliance, tablet inadequacies, intestinal malabsorption, increased metabolic degradation or hyperthyroidism; if the cause of the low serum level cannot be identified or corrected, serial serum measurements should enable safe and rational upward adjustment of dosage. In some patients with digitalis toxicity, the finding of a serum level which is relativity high for the dose prescribed may suggest that the patient is not sensitive to digitalis but rather is excreting it slowly; in such instances in elderly patients (with decreased glomerular filtration rates) and in patients with renal disease, serial digitalis measurements are useful adjuncts to clinical observation in determining optimal digitalis dosage schedules. A knowledge of serum digitalis concentrations should enable us to develop sound principles for a more rational approach to the clinical administration of cardiac glycosides, especially in patients with unusually high dosage requirements or with unusual sensitivity to relatively small doses of digitalis.

Topics: Animals; Antibodies; Antibodies, Anti-Idiotypic; Arrhythmias, Cardiac; Biological Availability; Cardiomyopathies; Cattle; Cooperative Behavior; Digitalis Glycosides; Digoxin; Drug Interactions; Drug Resistance; Humans; Infant; Intestinal Absorption; Malabsorption Syndromes; Radioimmunoassay; Tablets; Tachycardia; Tritium

Topics: Administration, Oral; Aged; Digitalis Glycosides; Digitoxin; Digoxin; Feces; Heart Atria; Heart Failure; Humans; Injections, Intramuscular; Injections, Intravenous; Intestinal Absorption; Kidney Diseases; Liver Diseases; Malabsorption Syndromes; Obesity; Tachycardia; Thyroid Diseases; Tritium; Water-Electrolyte Balance

Topics: Acute Disease; Aminophylline; Assisted Circulation; Cardiac Glycosides; Digoxin; Diuretics; Electric Countershock; Heart; Heart Diseases; Heart Failure; Humans; Morphine; Ouabain; Oxygen Inhalation Therapy; Phentolamine; Pulmonary Edema; Tachycardia; Vasodilator Agents

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: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrioventricular Node; Digitalis Glycosides; Digoxin; Diuretics; Electrocardiography; Fatigue; Female; Gastrointestinal Diseases; Glucose; Heart Block; Humans; Lidocaine; Male; Middle Aged; Phenytoin; Poisoning; Potassium; Procainamide; Saliva; Tachycardia; Time Factors; Vision Disorders

Topics: Arrhythmias, Cardiac; Bradycardia; Cardiac Complexes, Premature; Child; Child, Preschool; Deafness; Digoxin; Electric Countershock; Electrocardiography; Female; Heart Failure; Heart Ventricles; Humans; Infant; Infant, Newborn; Lidocaine; Male; Propranolol; Tachycardia; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

Topics: Acid-Base Equilibrium; Acidosis; Angiocardiography; Blood Gas Analysis; Blood Pressure; Bradycardia; Cardiac Catheterization; Cardiac Output; Child; Child, Preschool; Cineangiography; Cyanosis; Digoxin; Diuretics; Dyspnea; Electrocardiography; Heart Auscultation; Heart Block; Heart Defects, Congenital; Heart Failure; Heart Rate; Humans; Infant; Infant, Newborn; Oxygen Inhalation Therapy; Pulse; Referral and Consultation; Tachycardia; Vectorcardiography

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

Standardized treatment of fetal tachyarrhythmia has not been established.. This study sought to evaluate the safety and efficacy of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL).. In this multicenter, single-arm trial, protocol-defined transplacental treatment using digoxin, sotalol, and flecainide was performed for singleton pregnancies from 22 to <37 weeks of gestation with sustained fetal SVT or AFL ≥180 beats/min. The primary endpoint was resolution of fetal tachyarrhythmia. Secondary endpoints were fetal death, pre-term birth, and neonatal arrhythmia. Adverse events (AEs) were also assessed.. A total of 50 patients were enrolled at 15 institutions in Japan from 2010 to 2017; short ventriculoatrial (VA) SVT (n = 17), long VA SVT (n = 4), and AFL (n = 29). One patient with AFL was excluded because of withdrawal of consent. Fetal tachyarrhythmia resolved in 89.8% (44 of 49) of cases overall and in 75.0% (3 of 4) of cases of fetal hydrops. Pre-term births occurred in 20.4% (10 of 49) of patients. Maternal AEs were observed in 78.0% (39 of 50) of patients. Serious AEs occurred in 1 mother and 4 fetuses, thus resulting in discontinuation of protocol treatment in 4 patients. Two fetal deaths occurred, mainly caused by heart failure. Neonatal tachyarrhythmia was observed in 31.9% (15 of 47) of neonates within 2 weeks after birth.. Protocol-defined transplacental treatment for fetal SVT and AFL was effective and tolerable in 90% of patients. However, it should be kept in mind that serious AEs may take place in fetuses and that tachyarrhythmias may recur within the first 2 weeks after birth.

Topics: Administration, Oral; Adult; Anti-Arrhythmia Agents; Atrial Flutter; Cesarean Section; Digoxin; Female; Fetal Death; Fetal Diseases; Flecainide; Humans; Infant, Newborn; Injections, Intravenous; Japan; Natriuretic Peptide, Brain; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Care; Recurrence; Sotalol; Tachycardia; Tachycardia, Supraventricular; Umbilical Veins; Young Adult

A rapid heart rate (HR) during atrial fibrillation (AF) and atrial flutter (AFL) in left ventricular (LV) dysfunction often impairs cardiac performance. The J-Land study was conducted to compare the efficacy and safety of landiolol, an ultra-short-acting β-blocker, with those of digoxin for swift control of tachycardia in AF/AFL in patients with LV dysfunction.. The 200 patients with AF/AFL, HR ≥120beats/min, and LV ejection fraction 25-50% were randomized to receive either landiolol (n=93) or digoxin (n=107). Successful HR control was defined as ≥20% reduction in HR together with HR <110beats/min at 2h after starting intravenous administration of landiolol or digoxin. The dose of landiolol was adjusted in the range of 1-10µg·kg(-1)·min(-1) according to the patient's condition. The mean HR at baseline was 138.2±15.7 and 138.0±15.0beats/min in the landiolol and digoxin groups, respectively. Successful HR control was achieved in 48.0% of patients treated with landiolol and in 13.9% of patients treated with digoxin (P<0.0001). Serious adverse events were reported in 2 and 3 patients in each group, respectively.. Landiolol was more effective for controlling rapid HR than digoxin in AF/AFL patients with LV dysfunction, and could be considered as a therapeutic option in this clinical setting.

Topics: Adrenergic beta-1 Receptor Antagonists; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Female; Heart Rate; Humans; Male; Middle Aged; Morpholines; Prospective Studies; Tachycardia; Urea; Ventricular Dysfunction, Left

A population of 283 patients with recent onset (< 72 hours) AF, without heart failure, who received a single 450- or 600-mg oral dose of propafenone, or digoxin 1 mg, or placebo for conversion to sinus rhythm (SR), was studied to determine whether a routine admission to the hospital for drug administration is justified. Previous bradyarrhythmias or sick sinus syndrome (SSS), and concomitant use of antiarrhythmic drugs were exclusion criteria. None of the 283 patients studied experienced VT or VF and none of them needed implantation of a temporary pacemaker. Periods of atrial tachyarrhythmias with regularization of atrial waves and 1:1 AV conduction were observed in only two cases, both receiving placebo. No predictor of proarrhythmia was found among the clinical variables considered (age, etiology, arrhythmia duration, atrial dimension, and blood potassium). No serious hemodynamic adverse effects were noted in either group. The rates of conversion to SR after 4 hours were: 80 (57%) of 141 patients who received propafenone and 35 (25%) of 142 patients who received digoxin or placebo (P < 0.001). Acute oral treatment with propafenone is simple and effective for the conversion of recent onset AF to SR in patients without clinical signs of heart failure. The routine admission of these patients to the hospital is not necessary. Home-based administration of oral propafenone to a selected group of patients could significantly increase the cost effectiveness of this treatment.

Topics: Administration, Oral; Age Factors; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Function; Atrioventricular Node; Bradycardia; Cost-Benefit Analysis; Digoxin; Female; Forecasting; Heart Rate; Hemodynamics; Home Care Services; Humans; Male; Middle Aged; Pacemaker, Artificial; Patient Admission; Placebos; Potassium; Propafenone; Retrospective Studies; Sick Sinus Syndrome; Tachycardia; Tachycardia, Ventricular; Ventricular Fibrillation

We randomized 61 patients with paroxysmal atrial fibrillation (AF) ( < 48 hours from onset) to either sotalol or quinidine treatment. Conversion of rhythm was recorded by Holter monitoring. The starting 80 mg dose of sotalol was repeated at 2, 6, and 10 hours if AF persisted (heart rate > 80 beats/min), and if systolic blood was > or = 120 mm Hg. In the quinidine group, if heart rate > 100 beats/min, it was decreased with intravenous digoxin, whereafter 200 mg of oral quinidine sulfate was given maximally 3 times, each dose 2 hours apart. Conversion of AF to sinus rhythm occurred in 17 or 33 patients (52%) taking sotalol, and in 24 of 28 patients (86%) taking quinidine (p < 0.0001). Electric cardioversion was necessary in 39% of the former and in 14% of the latter group. The mean delay from first trial drug to sinus rhythm with the trial medication was 10.2 +/- 7.6 hours in the sotalol group and 4.0 +/- 2.9 hours in the quinidine group (p < 0.01). Treatment was discontinued in 16 patients taking sotalol (48%) because of asymptomatic bradycardia or hypotension, and in 20 taking quinidine (71%) because of rhythm conversion. Asymptomatic wide complex tachycardia (QRS > 0.12 second) was found in 13% and 27% of patients taking sotalol and quinidine, respectively. The longest RR intervals were 6.4 and 3.8 seconds in the sotalol and quinidine groups, respectively. Oral sotalol did not appear as effective as quinidine sulfate treatment in conversion of paroxysmal AF.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adult; Aged; Atrial Fibrillation; Digoxin; Drug Therapy, Combination; Female; Heart Rate; Humans; Male; Middle Aged; Quinidine; Sotalol; Tachycardia; Time Factors

In 50 patients with chronic congestive heart failure (CCHF, III or IV class), aged 62.8 +/- 9.1 years, who were treated with digoxin (Dx) and furosemide (F) (investigation A), continuous 24-hour ecg registration was performed according to Holter. Next, this treatment was extended by two-week administration of nifedipine (N) or isosorbide dinitrate (S) (investigation B), followed by one-month addition of captopril (Cp) (investigation C). During the last two weeks Dx, F, N or Dx, F, S were administered with Cp being withdrawn (investigation D). At the end of each stage of the treatment ecg registration was repeated according to Holter. At the same time, during the investigation A there were performed determinations of blood serum sodium, potassium and digoxin concentrations, two-dimensional echocardiography and evaluation of submaximal exercise tolerance. In 96 per cent of patients with CCHF, treated with Dx and F, cardiac rhythm disturbances were found. In 53.3 per cent life-threatening ventricular arrhythmias occurred, including unstable ventricular tachycardia in 11.1 per cent of patients. Addition of N or S to the classical treatment did not decrease either patient number or amounts of cardiac rhythm disturbances in individual classes according to Lown. Also Cp did not affect numbers of patients with cardiac rhythm disturbances, but it decreased numbers of patients with life-threatening ventricular arrhythmias from 53.3 per cent to 28.9 per cent (from 24/45 to 13/45). At the same time, Cp significantly decreased numbers of ventricular arrhythmias in class 3 and 4a (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Atrial Fibrillation; Captopril; Cardiac Output; Coronary Disease; Digoxin; Drug Therapy, Combination; Electrocardiography; Exercise Test; Female; Furosemide; Heart Block; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Isosorbide; Male; Middle Aged; Nifedipine; Tachycardia; Vasodilator Agents

Recent studies have led to controversy about whether long-term digoxin therapy after confirmed or suspected myocardial infarction increases mortality. We analyzed the mortality experience in 903 patients enrolled in the Multicenter Investigation of Limitation of Infarct Size (MILIS). As in previous studies, the decision to treat or not to treat with digoxin was made by the patient's personal physician on the basis of the usual clinical indications. Cumulative mortality was 28 percent for the 281 digoxin-treated patients as compared with 11 percent for the 622 patients who did not receive digoxin (P less than 0.001; follow-up interval, six days to 36 months; mean, 25.1 months). However, patients treated with digoxin had more base-line characteristics predictive of mortality than did their counterparts. Adjustment for these differences with two separate applications of the Cox method yielded P values of 0.14 and 0.34 for tests of difference in mortality, providing no evidence for a significant excess mortality associated with digoxin. Thus, the findings in the MILIS population do not support the assertion that digoxin therapy is excessively hazardous after infarction, but the existence of an undetected harmful effect can only be excluded with a randomized study. Until the results of such a study are available, we recommend careful consideration of whether any treatment of ventricular dysfunction is actually needed, consideration of alternatives to digoxin therapy, and restriction of digoxin use to the subgroup of patients (with severe chronic congestive failure and a dilated left ventricle) previously shown to have a beneficial clinical response.

Topics: Clinical Trials as Topic; Digoxin; Humans; Myocardial Infarction; Regression Analysis; Risk; Tachycardia

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

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

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

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

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

Discontinuation of digoxin in 56 patients with sinus rhythm who had been taking it for a long time did not produce clinical deterioration in 33 of 34 patients whose pre-withdrawal steady-state plasma-digoxin concentration was less than 0.8 ng/ml; fast atrial fibrillation developed in the other patient. 22 patients had plasma-digoxin levels between 0.8 and 2.0 ng/ml before withdrawal--of these, 7 deteriorated without digoxin (5 had atrial fibrillation, which was associated with congestive heart-failure, measurement of the pre-injection period/left-ventricular ejection time (P.E.P./L.V.E.T.) ratio suggested that digoxin did exert a sustained positive inotropic effect. Thus, successful discontinuation of digoxin was possible in 86% of the total group and was more likely when the plasma-digoxin concentration was below 0.8 ng/ml. Unexpected atrial fibrillation was the commonest development inthe 8 patients in whom digoxin withdrawal was unsuccessful.

Topics: Adult; Aged; Atrial Fibrillation; Clinical Trials as Topic; Digoxin; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Stimulation, Chemical; Substance Withdrawal Syndrome; 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

Patients with acute myocardial infarction were allocated to two groups according to a double blind-system of radomization. The patients (n = 18) in one of the groups received digoxin intravenously as an injection of 0.01 mg. per kilogram of body weight during 10 minutes. The patients in the other group (n = 15) received saline and served as controls. A continuous ECG record was obtained from each patient during 1 hour preceding the administration of digoxin or saline and was continued for 3 hours following the injection. No antiarrhythmic treatment was given during the time of the study. Based on the continuous ECG, calculations were made of the relative incidence of patients with different types of ventricular tachyarrhythmias during the period of observation as well as the percentage of arrhythmia-containing 1 minute intervals observed during this period. There was no statistical difference between the incidence of ventricular tachyarrhythmias in the two groups in the 1 hour period preceding drug injection. The administration of digoxin and saline did not change the incidence of ventricular tachyarrhythmias and there was also no statistically significant difference between the two groups as regards the incidence of patients showing different types of ventricular tachyarrhythmias during the 3 hour period following drug administration, Considering the 1-minute intervals, those without any ventricular premature contractions were less in the digoxin group (92 per cent) than in the saline group (88 per cent; p less than 0.001). Serum levels of digoxin at the end of the observation period were well above what is considered the minimum therapeutic level and in three patients the level approached or reached the toxic range. In these three patients there was still no increased incidence of ventricular tachyarrhythmias. It is concluded that patients with acute myocardial infarction complicated by incipient left ventricular failure do not show an increased sensitivity to an ordinary dose of digoxin as measured by the occurrence of ventricular tachyarrhythmia.

Topics: Acute Disease; Adult; Aged; Blood Pressure; Clinical Trials as Topic; Digoxin; Dose-Response Relationship, Drug; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Infusions, Parenteral; Male; Middle Aged; Myocardial Infarction; Tachycardia

Topics: Adult; Aged; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Benzothiadiazines; Digoxin; Disopyramide; Diuretics; Electrocardiography; Female; Humans; Male; Methyldopa; Middle Aged; Placebos; Potassium Chloride; Pyridines; Sodium Chloride Symporter Inhibitors; Tachycardia

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Berlin; Digoxin; Heart Block; Heart Failure; Humans; Myocardial Infarction; Myocardium; Oxygen Consumption; Tachycardia; Ventricular Fibrillation

While in-utero treatment of sustained fetal supraventricular arrhythmia (SVA) is standard practice in the previable and preterm fetus, data are limited on best practice for late preterm (34 + 0 to 36 + 6 weeks), early term (37 + 0 to 38 + 6 weeks) and term (> 39 weeks) fetuses with SVA. We reviewed the delivery and postnatal outcomes of fetuses at ≥ 35 weeks of gestation undergoing treatment rather than immediate delivery.. This was a retrospective case series of fetuses presenting at ≥ 35 weeks of gestation with sustained SVA and treated transplacentally at six institutions between 2012 and 2022. Data were collected on gestational age at presentation and delivery, SVA diagnosis (short ventriculoatrial (VA) tachycardia, long VA tachycardia or atrial flutter), type of antiarrhythmic medication used, interval between treatment and conversion to sinus rhythm and postnatal SVA recurrence.. Overall, 37 fetuses presented at a median gestational age of 35.7 (range, 35.0-39.7) weeks with short VA tachycardia (n = 20), long VA tachycardia (n = 7) or atrial flutter (n = 10). Four (11%) fetuses were hydropic. In-utero treatment led to restoration of sinus rhythm in 35 (95%) fetuses at a median of 2 (range, 1-17) days; this included three of the four fetuses with hydrops. Antiarrhythmic medications included flecainide (n = 11), digoxin (n = 7), sotalol (n = 11) and dual therapy (n = 8). Neonates were liveborn at 36-41 weeks via spontaneous vaginal delivery (23/37 (62%)) or Cesarean delivery (14/37 (38%)). Cesarean delivery was indicated for fetal SVA in two fetuses, atrial ectopy or sinus bradycardia in three fetuses and obstetric reasons in nine fetuses that were in sinus rhythm at the time of delivery. Twenty-one (57%) cases were treated for recurrent SVA after birth.. In-utero treatment of the near term and term (≥ 35-week) SVA fetus is highly successful even in the presence of hydrops, with the majority of cases delivered vaginally closer to term, thereby avoiding unnecessary Cesarean section. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Cesarean Section; Digoxin; Edema; Female; Fetal Diseases; Fetus; Humans; Hydrops Fetalis; Infant; Infant, Newborn; Pregnancy; Retrospective Studies; Tachycardia; Tachycardia, Supraventricular

Prognosis of fetuses with hydrops and tachyarrhythmia has been portrayed as poor in most published reports. This might lead to biased counselling, unnecessary caesarean section, preterm delivery, and even termination of pregnancy.. To evaluate contemporary fetal and postnatal outcomes of hydropic fetuses with fetal tachyarrhythmia when it is treated effectively and monitored systematically.. This is a retrospective review of a single centre experience at the University Hospital of Wales over a 20-year period. All fetuses received high doses of flecainide and digoxin combination treatment. Tachycardia response rate, time to arrhythmia and hydrops resolution, fetal and postnatal morbidity, and mortality rates were analysed.. Twenty fetuses were diagnosed with hydrops fetalis and received treatment. The mechanism of fetal tachyarrhythmia was supraventricular tachycardia in thirteen and atrial flutter in eight cases. Among the 20 fetuses treated, the overall tachycardia response rate was 90% (18/20) with the restoration of sinus rhythm in 85% (17/20) of the cases. The median time to restore sinus rhythm or to rate control of the arrhythmia was 1.5 days (range 12 hours to 13 days). Hydrops resolved in 17 of the 20 fetuses, with a median time of 12 days (range 3-21 days). Four fetuses went into spontaneous preterm birth and one fetus was delivered early due to worsening hydrops. No significant neurological morbidity was observed in surviving neonates and infants on clinical examination. There was one postnatal death due to respiratory complications of prematurity in the non-responsive supraventricular tachycardia case.. High-dose flecainide and digoxin combination offers effective treatment strategy in fetuses with hydrops and tachyarrhythmia with favourable outcomes. This study may guide more realistic counselling for pregnancies complicated by tachyarrhythmia and hydrops.

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cesarean Section; Digoxin; Female; Fetal Diseases; Flecainide; Heart Failure; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Premature Birth; Retrospective Studies; Tachycardia; Tachycardia, Supraventricular

Topics: Digoxin; Heart Failure; Humans; Tachycardia

Topics: Digoxin; Disease Progression; Drug-Related Side Effects and Adverse Reactions; Humans; Myocardial Infarction; Phenytoin; Tachycardia

Topics: Atrioventricular Block; Cardiac Complexes, Premature; Digoxin; Female; Fetus; Flecainide; Humans; Pregnancy; Sotalol; Tachycardia

Clinical experience with landiolol use in patients with atrial fibrillation (AF) and a severely depressed left ventricular (LV) function is limited. We compared the efficacy and safety of landiolol with that of digoxin as an intravenous drug in controlling the heart rate (HR) during AF associated with a very low LV ejection fraction (LVEF).We retrospectively analyzed 53 patients treated with landiolol (n = 34) or digoxin (n = 19) for AF tachycardias with an LVEF ≤ 25. The landiolol dose was adjusted between 0.5 and 10 μg/kg/minute according to the patient's condition. The response to treatment was defined as a decrease in the HR of ≤ 110/minute, and that decreased by ≥ 20% from baseline.There were no significant differences between the two groups regarding the clinical characteristics. The responder rate to landiolol at 24 hours was significantly higher than that to digoxin (71.0% versus 41.2%; odds ratio: 4.65, 95% confidence interval: 1.47-31.0, P = 0.048). The percent decrease in the HR from baseline at 1, 2, 12, and 24 hours was greater in the landiolol group than in the digoxin group (P < 0.01, P = 0.071, P = 0.036, and P = 0.016, respectively). The systolic blood pressure (SBP) from baseline within 24 hours after administering landiolol was significantly reduced, whereas digoxin did not decrease the SBP over time. Hypotension (< 80 mmHg) occurred in two patients in the landiolol group and 0 in the digoxin group (P = 0.53).Landiolol could be more effective in controlling the AF HR than digoxin even in patients with severely depressed LV function. However, careful hemodynamic monitoring is necessary when administering landiolol.

Topics: Administration, Intravenous; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Blood Pressure; Digoxin; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Morpholines; Retrospective Studies; Severity of Illness Index; Stroke Volume; Tachycardia; Treatment Outcome; Urea; Ventricular Dysfunction, Left

To explore the impact of digoxin on hemodynamic parameters in patients with sepsis and tachycardia admitted to the intensive care unit.. Retrospective review of adult patients admitted to the medical and mixed ICU at Mayo Clinic Rochester, Minnesota from March 2008 to February 2018, initiated on digoxin within 24 h of ICU stay. Hemodynamic parameters were reviewed before digoxin administration and at 6, 12 and 24 h after. Adverse events including new onset conduction abnormalities or arrhythmias during the first 48 h after digoxin administration were reviewed by a critical care cardiologist.. Study included 180 patients. We observed significant decrease in heart rate from 124 (115-138) beats/min 1 h before digoxin to 101 (87-117) 6 h after digoxin and 94 (84-112) 12 h after (p < .01). Median systolic blood pressure increased from 100 (91-112) mm Hg 1 h before to 110 (100-122) (p < .01) and 111 (103-124) at 6 and 12 h respectively after digoxin.. Early digoxin administration in patients with sepsis and tachycardia is uncommon but associated with improvements of hemodynamic parameters. These preliminary results will help formulate future hypotheses for focused trials on utility, efficacy and safety of digoxin in sepsis.

Topics: Aged; Blood Pressure; Cardiotonic Agents; Critical Care; Digoxin; Female; Heart Rate; Hemodynamics; Humans; Intensive Care Units; Male; Middle Aged; Retrospective Studies; Sepsis; Tachycardia

To evaluate maternal tolerance to digoxin, used alone or associated to other antiarrhythmic drugs in the management of fetal tachycardia.. This retrospective study was conducted at Rouen University Hospital between January 2009 and July 2016. All women who have received a treatment by either digoxin alone or associated with another antiarrhythmic drug for fetal tachycardia were included in the study. Maternal cardiac and extracardiac adverse effects were reported and comparisons between electrocardiograms before and during treatment with digoxin alone were performed.. Eighteen women were treated by digoxin, either alone or associated with another antiarrhythmic (sotalol, flecainide or amiodarone). During treatment, digoxin overdosing (>2ng/mL) was observed in 11 women (61%), among which 4 women had toxic levels of digoxinemia (>3ng/mL) that was symptomatic in 3 women. Cardiac complications such as sinus bradycardia, first-degree auriculo-ventricular block and Mobitz I second-degree auriculo-ventricular block were reported in four women (18.2%). Extracardiac side effects i.e. neurosensorial or digestive were diagnosed in 35.3% of women. The parameters of the electrocardiogram were not altered before and after treatment with digoxin alone.. Antiarrhythmics can cause maternal cardiac complications and extracardiac side effects that can sometimes be severe but rapidly reversible upon treatment arrest.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Electrocardiography; Female; Fetal Diseases; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Tachycardia

Topics: Anti-Arrhythmia Agents; Digoxin; Fetal Diseases; Flecainide; Humans; Tachycardia; Tachycardia, Supraventricular

Atrial flutter (AFL) is the second most common type of tachyarrhythmia in the fetus and neonate. An atrial rate of 240 to 360 beats per minute, 2:1 atrioventricular conduction, and a "saw tooth" appearance on electrocardiogram (ECG) are characteristic. On echocardiogram, bilateral atrial dilatation is the most common finding. Treatment is dependent on the severity of symptoms; delivery is usually indicated in the case of fetal heart failure or hydrops fetalis, whereas postnatal AFL is most commonly treated with direct current cardioversion (DCC). This article presents an illustrative case in which the patient presented antenatally via abnormal nonstress testing and subsequent fetal echocardiogram that was concerning for AFL. Postnatal ECG confirmed this diagnosis and the patient received DCC on the day of birth, followed by digoxin and propranolol as maintenance therapy.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Drug Therapy, Combination; Echocardiography; Electric Countershock; Electrocardiography; Female; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Pregnancy; Propranolol; Tachycardia

Topics: Aged, 80 and over; Anti-Arrhythmia Agents; Digoxin; Electrocardiography; Female; Humans; Male; Middle Aged; Tachycardia

Topics: Acute Disease; Aged; Cardiotonic Agents; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Failure; Humans; Systole; Tachycardia; Ventricular Dysfunction

Topics: Adrenergic beta-1 Receptor Antagonists; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Female; Heart Rate; Humans; Male; Morpholines; Tachycardia; Urea; Ventricular Dysfunction, Left

In recent years, digoxin use has been on the decline, with decreased incidence of digoxin toxicity. Hence, digoxin toxicity, when it occurs, remains an elusive diagnosis to emergency physicians.. To present a case of digoxin toxicity with normal levels of digoxin and serum potassium, but with severe hypomagnesemia.. A 66-year-old woman presented with junctional tachycardia and ectopic atrial tachycardia. She was known to have congestive cardiac failure on diuretic therapy. Her serum digoxin level was within the normal range (2.4 nmol/L [normal = 1.9-2.6]) along with a normal serum potassium level (3.9 mmol/L [normal = 3.5-5]). However, there was severe hypomagnesemia (0.39 mmol/L [normal = 0.65-1.25]) precipitating digoxin-induced dysrhythmia, which responded well to intravenous magnesium therapy.. This case reiterates that digoxin toxicity can occur in patients with normal digoxin and potassium levels, and in such patients, magnesium needs to be checked and treated to prevent potentially life-threatening dysrhythmias.

Topics: Aged; Anti-Arrhythmia Agents; Digoxin; Female; Humans; Magnesium; Potassium; Tachycardia

Topics: Adult; Anti-Arrhythmia Agents; Biomarkers; Blood Transfusion, Intrauterine; Case-Control Studies; Cytokines; Digoxin; Female; Fetal Diseases; Heart Failure; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia; Treatment Outcome; Young Adult

The force-frequency relationship (FFR) reflects alterations in intracellular calcium cycling during changing heart rate (HR). Tachycardia-induced heart failure is associated with depletion of intracellular calcium. We hypothesized (1) that the relative resistance to tachycardia-induced heart failure seen in neonatal pigs is related to differences in calcium cycling, resulting in different FFR responses and (2) that pretreatment with digoxin to increase intracellular calcium would modifies these changes. LV +dP/dt was measured during incremental right atrial pacing in 16 neonatal and 14 adult pigs. FFR was measured as the change in +dP/dt as HR was increased. Animals were randomized to control or intravenous bolus digoxin (n = 8 neonate pigs in the 0.05 mg/kg group and n = 7 adult pigs in the 0.025 mg/kg group) and paced for 90 min at 25 bpm greater than the rate of peak +dP/dt. Repeat FFR was then obtained. The postpacing FFR in neonatal control pigs shifted rightward, with peak force occurring 30 bpm greater than baseline (P < 0.03). There was no vertical shift; thus, force at 150 bpm decreased (P < 0.03) and force at 300 beats/min increased (P < 0.08). In adult control pigs, FFR shifted downward (P < 0.01), with decreased force generation at all HRs. In both neonates and adult pigs, digoxin increased +dP/dt at all HRs; however, in neonate pigs digoxin decreased the contractile reserve by abrogation of the rightward shift of FFR. An adaptive response to tachycardia in the neonate pig leads to improved force generation at greater HRs. Conversely, the response of the mature pig heart is maladaptive with decreased force generation. Pretreatment with digoxin modifies these responses.

Topics: Age Factors; Animals; Animals, Newborn; Calcium Channels; Cardiac Pacing, Artificial; Cardiotonic Agents; Cytoplasm; Cytosol; Digoxin; Electrocardiography; Heart Failure; Heart Rate; Models, Theoretical; Myocardial Contraction; Sarcoplasmic Reticulum; Swine; Tachycardia; Ventricular Function, Left

Sustained fetal tachyarrhythmia may result in congestive heart failure, hydrops fetalis, and fetal/neonatal death, which requires timely and appropriate therapy.. To determine the value of transplacental digoxin therapy for fetal tachyarrhythmia with multiple evaluations.. Four cases of fetal tachyarrhythmia were diagnosed with fetal echocardiography and treated with transplacental digoxin therapy with an initial dosage of 0.25 mg qd. Fetal echocardiography and measurement of maternal serum digoxin concentrations were performed every 5-7 days. Echocardiographic information was further used for the calculation of three evaluation systems including, Tei index, cardiovascular profile score (CVPS), and umbilical artery resistance index (UARI). The dosage of digoxin was adjusted according to the serum concentration, as well as results from three evaluation systems.. During the course of digoxin treatment, our patients show an increase of CVPS and decrease of Tei index and UARI, suggesting the recovery of heart function. Sinus rhythm was restored in 3-10 days in three cases and 42 days in one case. At the time of delivery, the placental transportation efficiency (neonate/mother ratio of serum digoxin concentration) was 76.45-84.31%. Following delivery, the general conditions of neonates were favorable. During the 4- to 14-month follow-up, reoccurrence of arrhythmia, neurological deficit, and retarded growth and development were not observed.. Transplacental digoxin therapy with combined evaluation of Tei index, CVPS, and UARI systems is useful for treating fetal atrial flutter (AF) and supraventricular tachycardia (SVT).

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Echocardiography; Female; Fetal Diseases; Fetal Monitoring; Fetal Movement; Gestational Age; Heart Rate, Fetal; Humans; Maternal-Fetal Exchange; Pregnancy; Tachycardia; Tachycardia, Supraventricular

Topics: Aged; Digitalis; Digoxin; Electrocardiography; Female; Humans; Tachycardia; Ventricular Fibrillation

Topics: Aged, 80 and over; Anti-Arrhythmia Agents; Digoxin; Electrocardiography; Female; Humans; Infusions, Intravenous; Tachycardia

Topics: Amiodarone; Anti-Arrhythmia Agents; Cardiac Electrophysiology; Digoxin; Female; Fetal Diseases; Humans; Pregnancy; Sotalol; Tachycardia

Cardiac arrhythmias and osteoporotic fractures are common in the elderly.. We studied whether tachyarrhythmia and/or the drugs used to treat arrhythmias affect risk of fracture.. In a population-based nation-wide pharmaco-epidemiological case-control design, we compared 124,655 patients that sustained a fracture during 2000 with 373,962 age- and gender-matched controls. We used computerized registers to assess individual drug use and related these data to individual fracture data and information on confounders.. Risk of any fracture was increased in patients with atrial fibrillation [Odds ratio (OR): 1.14; 95% confidence interval (95%CI): 1.08-1.21] and in patients currently treated with amiodarone (OR: 1.47; 95%CI: 1.21-1.78). Conversely, current use of digoxin decreased fracture risk (OR: 0.75; 95%CI: 0.71-0.79). Subanalysis showed similar effects in men and in women, but drug treatment only affected fracture risk in subjects older than 65 years of age. In current users of digoxin, risk of any fracture and risk of hip and forearm fracture decreased dose-dependently with increased dose. The use of other antiarrhythmics did not affect fracture risk.. Special attention should be paid to patients on treatment with amiodarone and/or a diagnosis of atrial fibrillation as they may have an increased risk of fracture. Conversely, treatment with digoxin may reduce fracture risk.

Topics: Adult; Age Factors; Aged; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Case-Control Studies; Digoxin; Dose-Response Relationship, Drug; Female; Forearm Injuries; Fractures, Bone; Hip Fractures; Humans; Male; Osteoporosis; Risk Factors; Sex Factors; Tachycardia

We report the case of a 78-year-old woman, with previous narrow QRS atrial fibrillation, who in the presence of mild digoxin intoxication and severe hyperkalaemia, caused by chronic renal failure and usage of potassium sparing drugs, presented on her ECG two distinct wide QRS tachycardias. Initial treatment with low doses of procainamide resulted in severe bradycardia. Her original rhythm was restored after partial correction of hyperkalaemia with haemodialysis under continuous infusion of lidocaine. The electrocardiographic manifestations of hyperkalaemia and digoxin intoxication as well as the effect of lidocaine and procainamide on hyperkalaemia-induced wide QRS tachycardias are discussed.

Topics: Aged; Anti-Arrhythmia Agents; Digoxin; Electrocardiography; Female; Heart Rate; Humans; Hyperkalemia; Potassium; Tachycardia

Fetal tachycardia complicated by ventricular dysfunction and hydrops fetalis carries a significant risk of morbidity and mortality. Transplacental digoxin is effective therapy in a small percentage, but there is no consensus with regard to antiarrhythmic treatment if digoxin fails. This study evaluates the safety, efficacy, and outcome of amiodarone therapy for digoxin-refractory fetal tachycardia with heart failure.. Fetuses with incessant tachycardia and either hydrops fetalis (n=24) or ventricular dysfunction (n=2) for whom digoxin monotherapy and secondary antiarrhythmic agents (n=13) were not effective were treated transplacentally with a loading dose of oral amiodarone for 2 to 7 days, followed by daily maintenance therapy for <1 to 15 weeks. Digoxin therapy was continued throughout gestation. Newborns were studied by transesophageal pacing or ECG monitoring to determine the mechanism of tachycardia. Three fetuses were delivered urgently in tachycardia during amiodarone loading, and 3 required additional antiarrhythmic agents for sustained cardioversion. Amiodarone or amiodarone combinations converted 14 of 15 (93%) with reentrant supraventricular tachycardia, 2 of 2 with ventricular or junctional ectopic tachycardia, and 3 of 9 (33%) with atrial flutter. Amiodarone-related adverse effects were transient in 5 infants and 8 mothers. Mean gestational age at delivery was 37 weeks, with 100% survival.. Orally administered amiodarone is safe and effective treatment for drug-refractory fetal tachycardia, specifically reentrant supraventricular tachycardia, junctional ectopic, or ventricular tachycardia, even when accompanied by hydrops fetalis or ventricular dysfunction.

Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Electrocardiography; Female; Fetal Diseases; Humans; Hydrops Fetalis; Male; Pregnancy; Tachycardia; Treatment Failure; Treatment Outcome; Ventricular Dysfunction

Medical treatment of fetal tachycardias has substantially improved neonatal outcome over the past years. Digitalis has been often used as first-line therapy in these cases, and more recently the use of several newer agents have been reported. We present four cases of fetal tachycardia with a favorable neonatal outcome after successful treatment with digitalis. Rapid transplacental digitalization appears to be an effective and reliable treatment option for fetal tachycardia, particularly in non-hydropic fetuses. In hydropic fetuses, however, digitalis alone appears to be less effective and administration of a second drug is usually needed.

Topics: Adult; Anti-Arrhythmia Agents; Cesarean Section; Digoxin; Female; Fetal Diseases; Humans; Male; Pregnancy; Recurrence; Tachycardia; Ultrasonography, Prenatal

Fetal tachycardia may lead to an increased pre- and postnatal morbidity and mortality rate particularly if it is complicated by cardial decompensation and hydrops fetalis.. In this study 33 fetal tachycardia cases diagnosed and treated between 1993 and 2004 in the fetal echocardiography unit of the I. Department of Obstetrics and Gynecology of the Semmelweis University, Budapest are reviewed. The data of postnatal care of the newborns delivered in the author's department from these pregnancies, and the follow up data provided by the National Institute of Cardiology are examined as well.. Mean gestational age at diagnosis of fetal tachycardia was 30 weeks (21-41 weeks). The tachyarrhythmias were classified into atrial flutter (n = 8), supraventricular tachycardia (n = 18), arrhythmia absoluta (n = 5), parasystole (n = 1) and brady-tachyarrhythmia (n = 1). Six cases were complicated by hydrops fetalis, 13 cases by cardial dysfunction. Transplacental antiarrhythmic therapy was applied in 22 cases, in 8 cases the newborns were delivered because of advanced gestational age, in 3 cases tachyarrhythmia resolved spontaneously or therapy was not indicated. The drug of first choice for transplacental therapy was digoxin, which was combined with amiodarone or verapamil (n = 10). Transplacental therapy led to cardioversion in 13/22 cases. The outcome of the 33 examined pregnancies was live birth in 27 cases, in utero death in 3 cases and 3 newborns were delivered elsewhere. The postnatal documentation of 24 newborns out of the 27 born in the author's department is available. At the time of birth 15/24 newborns were in sinus rhythm--out of whom 5 developed tachyarrhythmia later during the neonatal period--, 9/24 were tachycardic. Out of the 14 cases of tachyarrhythmia detected in the neonatal period altogether 3 resolved spontaneously, in 7 cases antiarrhythmic therapy was successful, in 4 cases unsuccessful. In 2 of these latter cases electrical cardioversion led to sinus rhythm. Neurological disorder was not detected in any case. In the early postnatal period 2 in utero severely decompensated newborns died. The follow-up data of 10 children is available, the follow-up period ranges between 6 weeks and 5 and a half years. All 5 children with history of supraventricular tachycardia are in sinus rhythm, 3 of them after suspending antiarrhythmic treatment, while the other 2 still on antiarrhythmic medication. Four out of 5 children with history of atrial flutter are in sinus rhythm, 2 of them left antiarrhythmic therapy, and 2 of them still take antiarrhythmic agents after electrical cardioversion. The atrial flutter of a 3 month old child could not be controlled yet permanently, despite several drug combinations applied.. Survival and late prognosis of tachycardic fetuses treated in utero is good. A prospective study of even more cases is required to establish uniform therapeutic guidelines and to provide appropriate follow-up data.

Topics: Amiodarone; Anti-Arrhythmia Agents; Digoxin; Electric Countershock; Female; Fetal Diseases; Follow-Up Studies; Gestational Age; Hemodynamics; Humans; Male; Retrospective Studies; Tachycardia; Tachycardia, Supraventricular; Verapamil

Bidirectional tachycardia is an uncommon and unique arrhythmia. It typically occurs in patients with digitalis toxicity, but it can also be associated with other causes. There has been controversy regarding the origin and the mechanism of bidirectional tachycardia. Treatment of bidirectional tachycardia involves the correction of reversible factors and the use of some antiarrhythmic medication.

Topics: Aged; Cardiomyopathies; Cardiotonic Agents; Cardiovascular Surgical Procedures; Digoxin; Electrocardiography; Female; Humans; Male; Monitoring, Intraoperative; Tachycardia

Topics: Animals; Anti-Arrhythmia Agents; Atenolol; Atrial Fibrillation; Diagnosis, Differential; Digoxin; Dog Diseases; Dogs; Electrocardiography; Fatal Outcome; Female; Heart Rate; Histiocytic Sarcoma; Tachycardia

Topics: Aged; Cardiotonic Agents; Confusion; Digoxin; Female; Humans; Hypokalemia; Muscle Weakness; Nursing Assessment; Risk Factors; Tachycardia; Vomiting

We discovered supraventricular tachycardia with advanced hydrops in the setting of normal cardiac anatomy at 26 weeks of gestation which resolved successfully following administration of digoxin and flecainide to the mother. A female baby was born after a premature rupture of the membranes at 30.6 weeks. The neonate was in sinus rhythm, showed a progressive regression of right ventricular insufficiency, but developed signs of acquired pulmonary valvar and subvalvar stenosis at 2 months of age.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Echocardiography, Doppler; Female; Flecainide; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Pulmonary Valve Stenosis; Tachycardia

A 27-week fetus with hydrops fetalis associated with fetal tachyarrhythmia and adenovirus infection was documented by viral polymerase chain reaction (PCR). The fetal tachyarrhythmia was converted to normal sinus rhythm by maternal pharmacological therapy with digoxin. Subsequently, resolution of the hydropic changes occurred and a viable normal-appearing preterm fetus at 29 weeks' gestation was delivered after preterm labour. This case demonstrates the first documented report of intrauterine adenovirus-associated fetal tachyarrhythmia and hydrops fetalis.

Topics: Adenoviridae; Adenoviridae Infections; Adult; Amniocentesis; Digoxin; DNA, Viral; Female; Fetal Diseases; Humans; Hydrops Fetalis; Infant, Premature; Polymerase Chain Reaction; Pregnancy; Prenatal Diagnosis; Tachycardia; Ultrasonography, Prenatal

Digoxin intoxication is a serious medical problem, and impairment of renal function is a common risk factor for toxicity. Digoxin specific antibody fragments (Fab) is the most effective treatment available for severe digitalis intoxication. The use of Fab therapy in a patient with renal disease is considered as effective as in patients with normal renal function, although the increased risk of rebound digoxin toxicity mandates a longer period of observation. In patients with kidney failure, neither digoxin nor Fab can be removed efficiently from the systemic circulation by hemodialysis or continuous arteriovenous hemofiltration. Knowledge about the clearance of both compounds by peritoneal dialysis is limited. The authors describe a patient with end stage renal disease who was treated with Fab and peritoneal dialysis for life threatening digoxin intoxication. Like other forms of dialysis, peritoneal dialysis, even when performed in an intensive schedule, is not associated with an enhanced clearance of digoxin.

Topics: Biological Availability; Bradycardia; Cardiotonic Agents; Digoxin; Drug Monitoring; Electrocardiography; Half-Life; Humans; Immunoglobulin Fab Fragments; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Tachycardia

Digoxin is widely used in the transplacental therapy of fetal tachyarrhythmia. Unfortunately, in cases with severe cardiac insufficiency and hydrops fetalis, transplacental passage of digoxin is often hampered and therapy therefore ineffective. The present study was designed to establish the isolated placental lobule to quantify transplacental digoxin passage under different experimental conditions. Ten human placentas were obtained immediately after delivery, and a lobule was dually perfused after cannulating a small artery and vein of the chorionic plate and piercing four catheters through the corresponding basal plate. Flow rates were 12 ml/min in the maternal circuit and 6 (I) respectively 3 ml/min (II) in the fetal circuit. The maternal circuit was spiked with digoxin to 6.18 +/- 0.40 ng/ml, and transplacental passage was calculated from repeated fetal and maternal perfusate samples (Fluorescence-Polarization-Immunoassay; TDx, Abbott Laboratories). Within three hours of recirculating perfusion with a fetal flow rate of 6 ml/min (I), digoxin concentrations in the maternal circuit (400 ml) declined to 3.56 +/- 0.09 ng/ml, whereas digoxin levels in the fetal compartment (200 ml) increased to 2.58 +/- 0.37 ng/ml. With a fetal perfusion rate of 3 ml/min (II), the efflux of digoxin out of the maternal circuit was lower (p < 0.05) and the influx in the total compartment was reduced (fetal digoxin concentrations reached only 26.9 +/- 10.6% vs. 39.1 +/- 5.5% of the initial maternal digoxin concentrations). These data suggest that severe fetal cardiac insufficiency with reduced placental perfusion may be in part responsible for the decrease of transplacental digoxin passage in fetuses with hydrops.

Topics: Anti-Arrhythmia Agents; Blood Flow Velocity; Digoxin; Female; Heart Failure; Humans; Hydrops Fetalis; Infant, Newborn; Maternal-Fetal Exchange; Metabolic Clearance Rate; Placenta; Pregnancy; Tachycardia

Three cases of chronic atrial tachycardia associated with ventricular dysfunction and severe exercise intolerance markedly improved within a few weeks when ventricular rate was slowed. Slowing ventricular rate may improve symptoms and ejection fraction despite possible changes in myocyte and tissue structure.

Topics: Adult; Cardiotonic Agents; Chronic Disease; Digoxin; Exercise Tolerance; Female; Heart Atria; Heart Rate; Humans; Male; Stroke Volume; Tachycardia; Ventricular Dysfunction, Left

Topics: Digoxin; Electrocardiography; Employment; Heart Function Tests; Humans; Illinois; Male; Medical Staff, Hospital; Nursing, Supervisory; Suburban Population; Tachycardia

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

An electrocardiographic classification of atrial tachycardia and its significance in children has not been reported. We reviewed the clinical histories and 12-lead surface electro-cardiograms (ECG) of 21 children with atrial tachycardia. Atrial rate and P-wave axis were determined for each patient. Some patients had features of typical atrial flutter (AF). Tachycardia was classified by atrial rate < 340/min or atrial rate > 340/min. Children with atrial tachycardia rate > 340/min consistently responded to conservative treatment (digoxin and/or cardioversion) without recurrences (p < 0.05 and p > 0.025); whereas in children with atrial rate < 340/min, only one case responded to conservative therapy. P-wave axis had no prognostic significance for either group. Additionally, high atrial rate (> 340/min) during tachycardia was noted in early infancy, compared to older children and adults, and probably represents the function of age. Classification of atrial tachycardia by rate is clinically useful for planning therapy and predicting response in children.

Topics: Adolescent; Atrial Flutter; Atrial Function; Child; Child, Preschool; Digoxin; Electric Countershock; Electrocardiography; Female; Humans; Infant, Newborn; Male; Prognosis; Tachycardia; Treatment Outcome

The diagnosis of fetal tachyarrhythmia during a routine ultrasound scan imposes a continuous monitoring of fetal heart function through ECG and M-mode echocardiography. Since fetal dysrhythmia can lead to non-immune hydrops or to fetal death a correct diagnosis and an adequate intrauterine therapy are fundamentally important. The authors report the results obtained through a transplacental therapy with digoxin or with digoxin-verapamil in 8 cases with supraventricular tachyarrhythmia. Digoxin was very successful for conversion in sinus rhythm in 4 cases. The combination digoxin-verapamil led to the conversion in only one case resistant to the digoxin therapy.

Topics: Digoxin; Drug Therapy, Combination; Echocardiography; Female; Fetal Diseases; Gestational Age; Humans; Placenta; Pregnancy; Remission Induction; Tachycardia; Ultrasonography, Prenatal; Verapamil

Topics: Adolescent; Adult; Atrial Flutter; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Heart Atria; Heart Defects, Congenital; Humans; Infant; Male; Middle Aged; Procainamide; Quinidine; Tachycardia

The relationship between levels of potassium in the serum and the development of malignant arrhythmias was examined in a retrospective study involving 1011 patients presenting with acute myocardial infarction. Thirteen percent of the overall patients studied had significant hypokalemia (k less than 3.5 mmol/liter). The average initial level of potassium in patients who developed malignant arrhythmias was (4.10 mmol/liter) significantly lower (P less than 0.01) than those patients who did not develop such arrhythmias (4.19 mmol/liter). To determine whether the level of potassium was, in itself, the primary cause of malignant arrhythmias following myocardial infarction, a subgroup analysis of factors influencing these levels was performed. It was determined that diabetics have a higher level of potassium than nondiabetics (4.2 mmol/liter versus 4.11 mmol/liter - P = 0.01) and a lower incidence of malignant arrhythmias (50.5% versus 63.5% - P = 0.002). No correlation was found between treatment with either digitalis or diuretics and malignant arrhythmias. Size and location of infarcted areas was found to have a direct relationship with development of arrhythmias. Size and location of infarctions, however, were not found to be related to levels of potassium in the serum. Our findings support and clarify earlier suggestions establishing the levels of potassium in the serum as an important causative factor, together with size and location of infarctions, in the development of malignant arrhythmias.

Topics: Adrenergic beta-Antagonists; Aged; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Diabetes Mellitus; Digoxin; Diuretics; Female; Heart Block; Homeostasis; Humans; Hyperkalemia; Hypokalemia; Male; Middle Aged; Myocardial Infarction; Potassium; Retrospective Studies; Tachycardia; Ventricular Fibrillation

Fourteen mothers were treated with flecainide for fetal atrial tachycardias associated with intrauterine cardiac failure. Twelve of the 14 fetuses responded by conversion to sinus rhythm. One of the 12 fetuses subsequently died in utero. The remaining fetuses suffered no morbidity and were alive and well 3 months to 2 years after delivery. The two fetuses in whom atrial tachycardia did not convert with flecainide were successfully treated with digoxin. These results compare favourably with previous forms of antiarrhythmic treatment. After recent reports of the side effects of flecainide treatment, however, it has been advised that this drug should be confined to high risk patients and those with life threatening arrhythmias. The use of flecainide for fetal arrhythmias should be limited to patients with severe fetal hydrops and supraventricular tachycardias. It should not be the first drug of choice in atrial flutter.

Topics: Cardiac Output, Low; Digoxin; Female; Fetal Death; Fetal Diseases; Flecainide; Humans; Pregnancy; Tachycardia

We describe a case of ventricular tachycardia in association with acute Coxsackie B4 virus infection occurring in an otherwise normal infant. The dysrhythmia responded to flecainide acetate.

Topics: Coxsackievirus Infections; Digoxin; Enterovirus B, Human; Female; Flecainide; Heart Rate; Humans; Infant; Tachycardia

Topics: Adult; Cri-du-Chat Syndrome; Digoxin; Female; Fetal Diseases; Humans; Maternal-Fetal Exchange; Pregnancy; Tachycardia

To investigate the mechanism of pressure related ventricular arrhythmias by examining them during atrioventricular (AV) block.. Complete AV block, where all ventricular beats are ectopic, was induced by AV node ablation and/or by toxic digitalisation, and rhythm changes were studied while arterial blood pressure was repeatedly raised and lowered.. 15 anaesthetised mongrel dogs, weight 15-28 kg, were used. AV block was induced in eight by chemical or mechanical ablation of the AV node. In five of these and in seven other dogs, 5.0-7.5 mg digoxin was also given.. Following AV block due to ablation, a heart rate increase (or no change) was found in 87.5% of 56 arterial pressure increases produced by elevation of an open arterial blood reservoir or by metaraminol infusion, but in only 21.8% of 55 pressure decreases caused by arterial bleeding (p much less than 0.001). Following AV block due to digitalisation, the equivalent figures were 96% of 50 pressure increases and 27.3% of 55 pressure decreases (p much less than 0.001). While arterial pressure was increased there was moderate acceleration of the escape rhythm, then appearance of premature ventricular beats, then non-sustained and finally sustained ventricular tachycardia. The reverse occurred, with some hysteresis, on decreasing the arterial pressure. In five of the digitalised animals, arterial pressure reduction to nearly zero caused reproducible sudden arrest, with resumption of the ordinary escape rhythm on increasing the pressure again.. The findings suggest the possibility of two kinds of ectopic rhythm in AV block: the "normal" escape rhythm which is only moderately affected by arterial pressure changes; and an "abnormal" faster pressure dependent rhythm which is generated by high arterial pressure and abolished by pressure near zero, as if there were a mechano-electrical association. This abnormal rhythm may prevail completely in digitalis toxicity so that if cardiac arrest occurs, no automaticity can be expected to appear unless arterial pressure is raised.

Topics: Animals; Arrhythmias, Cardiac; Atrioventricular Node; Blood Pressure; Digoxin; Dogs; Electrocardiography; Formaldehyde; Heart Block; Heart Rate; Heart Ventricles; Mechanoreceptors; Tachycardia; Ventricular Fibrillation

The efficacy of magnesium therapy in patients with ventricular tachycardia has previously been reported. Recently completed and ongoing studies validate earlier observations that potassium and magnesium supplementation may control other cardiac arrhythmias, particularly in hypomagnesemic patients. Magnesium treatment is a viable therapeutic option when other antiarrhythmic agents fail to suppress ventricular tachycardia, ventricular fibrillation, multifocal atrial tachycardia, atrial fibrillation and supraventricular tachycardia.

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Female; Humans; Magnesium; Magnesium Deficiency; Male; Middle Aged; Tachycardia

A newborn infant with complete atrioventricular dissociation and infranodal tachycardia, detected at 33 weeks gestation by fetal echocardiography, is described. In the perinatal period, infra or juxta-nodal tachycardia was noted, compromising the hemodynamic state of the newborn. A combination of flecainide and propranolol terminated the arrhythmia.

Topics: Atrioventricular Node; Bundle of His; Cesarean Section; Diagnosis, Differential; Digoxin; Echocardiography; Electrocardiography; Female; Flecainide; Heart Conduction System; Humans; Infant, Newborn; Infusions, Intravenous; Pregnancy; Prenatal Diagnosis; Procainamide; Tachycardia

Drug efficacy and pharmacokinetics were assessed in 63 patients, aged 5 days to 30 years (mean 8 years), who received flecainide acetate for control of resistant arrhythmias. Doses of flecainide ranged from 59 to 225 mg/m2 body surface area per day (mean 141) in divided doses every 8 to 12 h and serum trough levels ranged from 0.10 to 0.99 micrograms/ml (mean 0.36). Flecainide controlled or partially controlled arrhythmia in 53 (84%) of the 63 patients: 7 of 7 patients who had the permanent form of junctional reciprocating tachycardia, 12 of 13 who had an atrial ectopic tachycardia, 10 of 10 who had ventricular tachycardia and 18 of 25 patients who had reentrant supraventricular tachycardia. Five of seven patients who had the latter arrhythmia were unsuccessfully treated with flecainide. They had Wolff-Parkinson-White syndrome and developed asymptomatic, incessant, slower orthodromic reciprocating tachycardia while receiving the drug. Transient blurred vision was reported in three patients and two patients had transient hyperactivity. No significant hemodynamic side effects were seen in any patient. Twenty-five patients underwent oral pharmacokinetic investigation. Young infants (less than 1 year of age) had a mean plasma elimination half-life (t 1/2) approximating that (11 to 12 h) found in older children and healthy adults; children aged 1 to 12 years had a shorter mean t 1/2 of 8 h. Dosing schedules based on milligrams per square meter body surface area correlated better with plasma flecainide levels than did dosing based on milligrams per kilogram body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adolescent; Adult; Arrhythmias, Cardiac; Child; Child, Preschool; Digoxin; Echocardiography; Electrocardiography; Flecainide; Follow-Up Studies; Half-Life; Humans; Infant; Tachycardia; Wolff-Parkinson-White Syndrome

Flecainide acetate has a recognized proarrhythmic effect in patients treated for ventricular tachycardia. Three patients developed severe ventricular arrhythmias while taking flecainide for atrial fibrillation. Patient 1 had normal ventricular function and idiopathic atrial fibrillation. Treadmill exercise tests during digoxin therapy showed no ventricular arrhythmia; however, during flecainide therapy the patient developed ventricular flutter at his peak exercise level that required cardioversion. Patient 2 had normal ventricular function and a prosthetic mitral valve. During therapy with flecainide, 150 mg twice daily, he had an episode of sustained ventricular tachycardia, also at his peak exercise level. Patient 3 had paroxysmal atrial fibrillation and hypertrophic cardiomyopathy but no previous ventricular arrhythmia. She died suddenly within 10 days of starting flecainide therapy. Judged from previous findings none of these patients was considered at high risk for proarrhythmia. These cases suggest a possible relation between vigorous exercise, atrial fibrillation, and the proarrhythmic properties of flecainide and indicate the limitations of classifying patients as "high-risk" or "low-risk" for proarrhythmic complications of anti-arrhythmic therapy.

Topics: Adult; Atrial Fibrillation; Digoxin; Drug Therapy, Combination; Electrocardiography; Exercise Test; Female; Flecainide; Heart Ventricles; Humans; Male; Tachycardia; Ventricular Fibrillation

A fetal cardiac arrhythmia may cause misleading fetal heart rate tracings with unreliable signs of fetal distress. Assessment of such artifacts and of the hemodynamic relevance of a fetal arrhythmia by alternative methods is necessary for management and therapy. A 28-year-old healthy woman was referred at 30 weeks of gestation because of fetal tachy-brady-arrhythmia, but cw-Doppler assessment of umbilical artery blood flow revealed periods of pseudobradycardia during bigeminal and trigeminal fetal pulse. FHR turned to regular tachycardia, and transplacental digitalization was started. Between 32 and 34 weeks the patient discontinued her digitalis intake, and a fetal pericardial effusion indicated subsequent cardiac failure. Serial pulsed Doppler measurements of fetal aortic blood flow were performed and imminent heart failure was recognized after the digitalis was discontinued and before a pericardial effusion occurred. Furthermore, improvement of fetal cardiac performance secondary to restarting digitalis and also prior to resolution of the pericardial effusion. After spontaneous delivery a Wolff-Parkinson-White syndrome was diagnosed, and continuation of digoxin treatment was indicated. Cw-Doppler assessment of umbilical artery blood flow was a suitable method to evaluate questionable FHR recordings, and pulsed Doppler allowed monitoring of the therapeutic effect of transplacental digitalization by serial measurements of fetal aortic blood flow.

Topics: Adult; Depression, Chemical; Digoxin; Female; Fetal Monitoring; Heart Rate, Fetal; Hemodynamics; Humans; Pregnancy; Tachycardia; Ultrasonography; Umbilical Arteries

We have previously described a method for inducing atrial ectopic tachycardia (AET) in the anesthetized adult rat using digoxin, 30 mg/kg s.c. In this study, we used this model to study digoxin-verapamil interactions in young and older male rats and have found age-related differences in their responses to digoxin alone and to digoxin-verapamil interactions as well. Overall, 90% of the animals of both groups combined that developed AET, developed a ventricular proarrhythmic response to verapamil. Thus, this model might broaden the pre-clinical evaluation of anti-arrhythmic agents and predict which drugs are most likely to have a proarrhythmic effect.

Topics: Aging; Animals; Digoxin; Drug Interactions; Electrocardiography; Heart Rate; Male; Rats; Rats, Inbred Strains; Tachycardia; Verapamil

Topics: Digoxin; Female; Fetal Diseases; Humans; Hydrops Fetalis; Pregnancy; Tachycardia; Verapamil

Topics: Aged; Aged, 80 and over; Digoxin; Electrocardiography; Emergencies; Female; Heart Block; Humans; Male; Tachycardia

During 1980-7, 23 pregnancies of 22-38 weeks' duration were investigated for fetal tachycardia. Twelve were cases of supraventricular tachycardia, eight of atrial flutter, and three cases in which the rhythm varied between supraventricular tachycardia and atrial flutter. In 11 cases the fetus had developed non-immune fetal hydrops before referral; 12 cases were non-hydropic at referral but one of this group of fetuses became hydropic during treatment. No relation was found between the rate or type of arrhythmia and the presence or absence of intrauterine heart failure. One non-hydropic infant was delivered electively prematurely. Maternal antiarrhythmic treatment was instituted in the remaining 22 cases. Conversion of the arrhythmia was achieved with digoxin alone in five cases and with a combination of digoxin and verapamil in nine. Control of the arrhythmia was achieved in seven of the 10 non-hydropic fetuses, and all were delivered at term with no deaths. Of the 12 hydropic fetuses, control was achieved in seven. Only three of the hydropic fetuses were delivered close to term. There were two deaths, both in the hydropic group. Of the whole group, five neonates suffered severe complications of prematurity. In this series the main benefit of treatment appeared to be in prolonging gestation of those hydropic fetuses in which conversion was achieved.

Topics: Delivery, Obstetric; Digoxin; Drug Therapy, Combination; Edema; Female; Fetal Diseases; Heart Failure; Heart Rate, Fetal; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Tachycardia; Verapamil

In isolated Purkinje fibers, digitalis intoxication induces triggered activity, which is based upon delayed afterdepolarizations. The characteristics of delayed afterdepolarizations have been studied systematically by programmed electrical stimulation. The present investigations were done to study the role of triggered activity during digitalis intoxication in the intact heart. For this purpose, a pacing protocol, similar to that used in experiments of isolated Purkinje fibers, was used. The experiments were done on conscious dogs with chronic complete atrioventricular block. Ventricular tachycardia was induced with digoxin IV 0.1 mg/kg/1-1 1/2 hr. The effect of programmed electrical stimulation on the first post-pacing interval was determined during sustained ventricular tachycardia and, following its spontaneous termination during an episode when ectopic activity could only be induced by pacing. During sustained ventricular tachycardia there was a direct linear relation between the interstimulus interval of regular pacing and the first post-pacing interval. During the episode when ectopic activity could only be induced by pacing, shortening of the post-pacing interval resulted in biphasic behavior of the first post-pacing interval. Pacing with interstimulus intervals of more than 400 ms induced a first post-pacing interval equal to the interstimulus interval, whereas shorter interstimulus intervals induced a first post-pacing interval twice the interstimulus interval. When during regular pacing only the last pacing interval was changed, a similar biphasic response resulted. When toxicity had almost subsided, ectopic activity could only be induced following short pacing intervals (200-320 ms). Again, a direct linear relation was found between the pacing interval and the first post-pacing interval. Our findings strongly suggest that at different levels of digitalis intoxication triggered activity is the underlying mechanism for the first post-pacing QRS complex.

Topics: Animals; Bundle of His; Cardiac Pacing, Artificial; Digoxin; Dogs; Dose-Response Relationship, Drug; Electrocardiography; Female; Heart Block; Heart Rate; Heart Ventricles; Male; Software; Tachycardia

The authors report two cases of fetal tachycardia treated in utero by digitalis (Digoxin) and a beta-blocker (Sotalol). The first case did well on treatment but the second case gave rise to difficulties in treatment both before and after delivery. A study of the literature and an analysis of our findings makes it possible for us to point out the following: echotomography is valuable in screening for fetal cardiac rhythm troubles and echocardiography is useful to work out the cause and to follow the progress of the case, this condition can be treated in utero and Sotalol, a beta-blocker, is valuable in overcoming the troubles of the rhythm, it is difficult to follow up the treatment by relying on maternal blood levels of the drugs used, finally the cause of the abnormal rhythm possibly alters the expectation of success from the treatment.

Topics: Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Fetal Diseases; Humans; Pregnancy; Sotalol; Tachycardia

Topics: Digoxin; Echocardiography; Female; Fetal Diseases; Humans; Maternal-Fetal Exchange; Monitoring, Physiologic; Pregnancy; Pregnancy Trimester, Third; Tachycardia

Topics: Adult; Amiodarone; Digoxin; Female; Fetal Diseases; Humans; Pregnancy; Tachycardia

The electrocardiographic response of digoxin-induced fascicular tachycardia to Fab fragments was evaluated in two patients. In addition, we documented the response of the fascicular tachycardia to spontaneous premature ventricular depolarizations during different tachycardia rates, the response to a nonsustained episode of ventricular tachycardia, and the mode of spontaneous initiation and termination of short-lived episodes of the tachycardia during the treatment process. The following findings were noted: slowing of the tachycardia in response to Fab administration; change in the morphologic characteristics of the tachycardia from multiform to uniform; resetting of the tachycardia by spontaneous premature ventricular depolarization with the return cycle equal to the observed tachycardia cycle length; acceleration of the tachycardia in response to five beats of a faster nonsustained ventricular tachycardia; and initiation and termination of the tachycardia, both by spontaneously occurring premature ventricular depolarizations and in the absence of premature ventricular depolarizations. Both tachycardias resolved completely within 20 and 40 minutes, respectively, of Fab administration. We conclude that Fab administration can promptly resolve fascicular tachycardias precipitated by digoxin toxicity and that the observed electrocardiographic phenomena strongly suggest triggered activity as the electrophysiologic mechanism of fascicular tachycardia in man.

Topics: Aged; Antibody Specificity; Biomechanical Phenomena; Digoxin; Electrocardiography; Female; Humans; Immunoglobulin Fab Fragments; Immunoglobulin Fragments; Immunotherapy; Male; Tachycardia

Topics: Adult; Atrial Fibrillation; Blood Proteins; Cardenolides; Digoxin; Humans; Saponins; Sodium-Potassium-Exchanging ATPase; Tachycardia; Time Factors

The epidemiology of prescribing long-term digoxin was studied in 241 patients from six group general practices. Each patient was assessed for the initial reason for prescribing digoxin and present clinical status, and the serum digoxin concentration was measured between six and 12 hours after the previous dose.The results show that digoxin was most commonly prescribed for elderly patients; 90% of patients were aged 60 years or more. The reasons for prescribing digoxin were considered adequate in only 55% of the total group; 71% of the patients were judged to be clinically well and 75% of the 95 patients with atrial fibrillation had ventricular rates of less than 90 beats per minute. ;Therapeutic' serum digoxin concentrations (0.8-2.0 ng ml(-1)) were observed in only 48% of patients; the level was sub-therapeutic in 46% and potentially toxic in 6%. No clear-cut relationship was found between clinical well-being and serum digoxin concentration. The type of supervision (whether hospital or general practice) did not affect appropriateness of prescribing, clinical well-being or likelihood of achieving a therapeutic serum digoxin level.This study would suggest the need for critical review of digoxin therapy in all patients who are taking it long-term. In some patients its continuance would appear unnecessary; in others, efficacy may be improved either by dose adjustment or by ensuring compliance. On occasions, particularly in patients with sinus rhythm, measurement of serum digoxin concentrations may prove helpful in this evaluation.

Topics: Adult; Aged; Aged, 80 and over; Digoxin; Drug Utilization; Family Practice; Female; Heart Failure; Humans; Male; Middle Aged; Tachycardia

Fetal cardiac arrhythmias are being diagnosed with increased frequency through ultrasonography and electronic fetal heart rate monitoring. Although many of them are benign, some, particularly supraventricular fetal tachycardia, have been associated with a poor outcome. Fetal hydrops and other evidence of fetal cardiac failure resulting from the elevated heart rate have been reported on. Although several modes of treatment have been described, the mainstay of cardioversion in utero continues to be digoxin. This case report demonstrates the need for prompt delivery when in utero cardioversion fails.

Topics: Administration, Oral; Adult; Cesarean Section; Digoxin; Female; Fetal Diseases; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Tachycardia

The proarrhythmic potential of digoxin, administered in a therapeutic dosage regimen, was evaluated in conscious dogs in the subacute phase of myocardial infarction. In this evaluation, digoxin (0.0125 mg/kg/day intravenously) or vehicle were administered to conscious dogs for periods of 5 to 7 days, commencing 4 to 5 days after anterior myocardial infarction. Before treatment, programmed ventricular stimulation failed to initiate ventricular tachycardia in 26 post infarction dogs. After treatment, programmed stimulation initiated ventricular tachyarrhythmias in only 1 of 13 digoxin-treated dogs (1.36 +/- 0.17 ng/ml serum digoxin) and in 0 of 13 vehicle-treated dogs. However, the incidences of early ventricular fibrilation (4 of 10 digoxin vs 0 of 12 vehicle; p less than 0.05) and of 24-hour mortality (6 of 10 digoxin vs 2 of 12 vehicle; p less than 0.05) occurring in response to the development of posterolateral ischemia in the presence of previous anterior myocardial infarction was significantly greater in digoxin-treated (1.47 +/- 0.19 ng/ml serum digoxin) than in vehicle-treated animals. These findings suggest an enhanced susceptibility toward the development of ischemia-related lethal arrhythmias in the presence of therapeutic digoxin serum concentrations early after myocardial infarction, which is not predicted by programmed ventricular stimulation testing.

Topics: Animals; Cardiac Pacing, Artificial; Consciousness; Digoxin; Dogs; Electrocardiography; Electrophysiology; Male; Myocardial Infarction; Potassium; Risk; Tachycardia; Time Factors; Ventricular Fibrillation

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

Quinidine therapy is one of the most common causes of the acquired long QT syndrome and torsade de pointes. In reviewing clinical data in 24 patients with the quinidine-associated long QT syndrome, 20 of whom had torsade de pointes, we have delineated several heretofore unreported or underemphasized features. (1) This adverse drug reaction occurred either in patients who were being treated for frequent nonsustained ventricular arrhythmias or for atrial fibrillation or flutter. (2) In patients being treated for atrial fibrillation, torsade de pointes occurred only after conversion to sinus rhythm. (3) Although most patients developed the syndrome within days of starting quinidine, four had torsade de pointes during long-term quinidine therapy, usually in association with hypokalemia. (4) Because of the large experience with this entity at our institution, we have been able to estimate the risk as at least 1.5% per year. (5) Twenty of the 24 patients had at least one major, easily identifiable, associated risk factor including serum potassium below 3.5 mEq/L (four); serum potassium between 3.5 and 3.9 mEq/L (nine); high-grade atrioventricular block (four); and marked underlying, (unrecognized) QT prolongation (two). Plasma quinidine concentrations were low, being at or below the lower limit of the therapeutic range in half of patients. The ECG features typically included absence of marked QRS widening, marked QT prolongation (by definition), and a stereotypic series of cycle length changes just prior to the onset of torsade de pointes. Torsade de pointes started after the T wave of a markedly prolonged QT interval that followed a cycle that had been markedly prolonged (usually by a post ectopic pause).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Digoxin; Electrocardiography; Female; Heart Ventricles; Humans; Long QT Syndrome; Male; Middle Aged; Potassium; Quinidine; Tachycardia

Topics: Digoxin; Electrocardiography; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Tachycardia

Fetal echocardiography now affords an accurate clinical diagnosis of nonimmune fetal hydrops secondary to fetal tachyarrhythmias and/or certain types of congenital heart disease. Individual case reports of the treatment of tachyarrhythmias have been reported that use various drugs, including digoxin, propranolol hydrochloride, procainamide hydrochloride, and digoxin plus verapamil hydrochloride. We found no report of intrauterine treatment of congestive heart failure due to congenital heart disease with sinus rhythm. The seven cases presented herein include five cases of isolated supraventricular tachycardia, one with supraventricular tachycardia and myocardial tumors, and one of congenital heart disease with congestive heart failure. Maternal treatment with digoxin converted tachyarrhythmia to sinus rhythm in all six fetuses, and resolved the hydrops in the fetus with congenital heart disease. Premature delivery was avoided in five of the seven cases with favorable outcome in six of the cases. In five mothers who were given oral digitalization, the fetuses had delayed (three to 35 days) response to therapy. Two mothers were treated intravenously and the fetus responded to therapy in less than 24 hours. Because of problems possibly related to poor absorption and/or rapid clearance of digoxin, the intravenous route of administration should be used as the best way to achieve adequate therapeutic levels in the fetus.

Topics: Atrioventricular Node; Digoxin; Echocardiography; Female; Heart Atria; Heart Failure; Humans; Infusions, Parenteral; Pregnancy; Prenatal Diagnosis; Tachycardia

Sixteen patients with multifocal atrial tachycardia (MAT) who were taking theophylline were identified over 6 months. After theophylline was discontinued the atrial rate fell and MAT resolved in all sixteen patients. Five patients were challenged with intravenous aminophylline to investigate the role of theophylline in the genesis of MAT. MAT with a rapid ventricular response occurred in all five even though metabolic and respiratory variables did not change. MAT returned on challenge in three patients in whom serum theophylline levels were within the generally accepted therapeutic range (10-20 mg/l). In individual patients, theophylline had a dose-related effect on the atrial rate and the amount of ectopic atrial activity. Thus, theophylline may commonly precipitate MAT and treatment with the drug should be carefully considered in patients with respiratory insufficiency and MAT.

Topics: Aged; Aminophylline; Blood Gas Analysis; Digoxin; Female; Heart Atria; Heart Rate; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Potassium; Tachycardia; Theophylline

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

A case of fetal supraventricular tachycardia (SVT) diagnosed by fetal echocardiography at 31 weeks gestation and successfully converted in utero is reported. Administration of digoxin orally to the mother resulted in very brief periods of normal fetal cardiac rhythm. Intravenous administration of verapamil to the mother resulted in sustained conversion to normal fetal sinus rhythm. Maintenance therapy with oral digoxin and verapamil was given to the mother for the remainder of the pregnancy with no recurrence of the fetal arrhythmia.

Topics: Administration, Oral; Adult; Digoxin; Drug Therapy, Combination; Echocardiography; Female; Fetal Diseases; Humans; Injections, Intravenous; Maternal-Fetal Exchange; Pregnancy; Tachycardia; Verapamil

During treatment with amiodarone, digoxin and nadolol, asystole occurred repeatedly in a patient with chronic persistent automatic atrial tachycardia. Asystole did not occur after discontinuation of drug therapy, and rechallenge with amiodarone alone produced marked overdrive suppression of all pacemakers resulting in asystole. Amiodarone serum level was within therapeutic range. The possible electrophysiologic mechanisms by which amiodarone might suppress both normal and abnormal pacemakers are discussed. The occurrence of asystole at therapeutic serum concentration of amiodarone suggests that this drug should be used with caution.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Benzofurans; Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Heart Arrest; Heart Atria; Heart Rate; Humans; Nadolol; Propanolamines; Tachycardia

Fetal supraventricular tachycardia was converted successfully with digoxin, and the congestive heart failure resolved. Previous case reports of fetal supraventricular tachycardia have established guidelines for its treatment; digoxin remains the drug of choice.

Topics: Adult; Digoxin; Female; Fetal Diseases; Fetal Heart; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia; Ultrasonography

Ultrasound is becoming more and more important in the routine care of antenatal patients. It makes it possible to diagnose a certain number of fetal abnormalities and in particular fetoplacental oedema whether it is caused by immunological or other factors. If oedema is associated with fetal cardiac arrhythmic conditions it can in certain cases be treated and cured in utero. This work analyses 11 cases of fetal oedema diagnosed by routine ultrasound in the years between 1977 and 1984.

Topics: Adult; Digoxin; Edema; Female; Fetal Diseases; Humans; Pregnancy; Tachycardia; Ultrasonography; Verapamil

Incessant reciprocating tachycardia (IRT) was diagnosed in 10 children aged 0-11 years (mean 2.5 years), followed-up for an average of 11 years (range 4-22 years). 8 children were treated for an average period of 2.8 years (range 0.5-6 years) with the association of amiodarone and digitoxine. All children were treated initially or secondarily with verapamil and/or betablockers with digitoxine for an average of 4.6 years (range 1-9 years). The true frequency of IRT, its tolerance and the age at diagnosis did not indicate the probable required length of treatment with amiodarone, but only the initial response to this drug. Finally, 5 patients were cured and in sinus rhythm, and the other 5 were well controlled, having only occasional bursts of tachycardia. When we compared one group of 5 cases with clinical signs of cardiac failure and radiological cardiomegaly (CTR greater than 0.60) with a second group of 5 cases in which the arrhythmia was better tolerated, surprisingly, the frequency of intreated IRT was not t he factor which influenced its tolerance (198/min vs 194/min). On the other hand, the following differences were observed between the two groups: a younger age at diagnosis in the first group (5 months vs 4.6 years) responsible for the longer follow-up period (14.5 vs 7 years), earlier treatment period with amiodarone (3.6 years compared to 5.5 years) and a longer treatment period with this drug (3.5 vs 2 years). It was only at about the age of 7 that this treatment could be withdrawn or changed with half the children completely cured, and the other half only controlled.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amiodarone; Child; Child, Preschool; Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Follow-Up Studies; Humans; Infant; Male; Tachycardia; Time Factors

The records of 90 patients with Wolff-Parkinson-White syndrome who presented with supraventricular tachycardia in the first 4 months of life were reviewed. Among these, 63% were male. Structural heart disease was present in 20%, most commonly Ebstein's anomaly. All patients presented with a regular narrow QRS tachycardia, and pre-excitation became evident only when normal sinus rhythm was established. Only one infant had atrial flutter and none had atrial fibrillation. Type A Wolff-Parkinson-White syndrome was most common (49%), with heart disease occurring in only 5% of these patients. In contrast, heart disease was identified in 45% of those with type B syndrome. Initially, normal sinus rhythm was achieved in 88% of the 66 infants treated with digoxin with no deaths. Normal sinus rhythm resumed after electrical countershock in 87% of the 15 infants so treated. Maintenance digoxin therapy was used in 85 patients. The Wolff-Parkinson-White pattern disappeared in 36% of the patients. Four infants died of cardiac causes during the mean follow-up period of 6.5 years. Two of these four infants had congenital heart disease; the third, with a normal heart initially, developed ventricular fibrillation and died from a cardiomyopathy considered related to resuscitation. The remaining infant, with a normal heart, died suddenly at 1 month of age. All were receiving digoxin. A wide QRS tachycardia later appeared in three patients, all with heart disease, one of whom died.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Combined Modality Therapy; Digoxin; Ebstein Anomaly; Electric Countershock; Electrophysiology; Female; Follow-Up Studies; Heart Conduction System; Humans; Infant; Infant, Newborn; Male; Recurrence; Sinoatrial Node; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Digoxin; Electrocardiography; Heart Conduction System; Humans; Infant; Male; Phenytoin; Propranolol; Tachycardia

Transesophageal atrial pacing was used to initiate and terminate tachycardia in 24 infants (seven female and 17 male, aged 1 to 34 days) with ECG documentation of supraventricular tachycardia. Six infants received no chronic treatment, and chronic oral digoxin prophylaxis was administered to 18 infants in an effort to prevent recurrences of tachycardia. In these 18 infants, the effectiveness of digoxin therapy in preventing the initiation of tachycardia by transesophageal pacing was compared with its ability to prevent spontaneous recurrences of supraventricular tachycardia. While receiving chronic oral digoxin therapy, tachycardia could be reinitiated in 15/18 (83%) infants. In these infants, the cycle length of tachycardia and the atrioventricular interval were the same before and during chronic digoxin treatment. Three infants in whom tachycardia could not be initiated during chronic digoxin therapy had no spontaneous recurrences during 6 months of follow-up, whereas 10/15 (67%) infants in whom tachycardia could be reinitiated had clinically significant recurrences in spite of chronic digoxin therapy. Six infants who received no chronic drug treatment had no documented recurrences during 6 months of follow-up. This study demonstrates that digoxin was effective in preventing significant spontaneous recurrences of supraventricular tachycardia in only 8/18 (44%) infants treated with digoxin. The ability to initiate supraventricular tachycardia with transesophageal pacing may be useful in determining which digoxin-treated infants are at risk for recurrence. Finally, not all infants with supraventricular tachycardia require chronic prophylaxis; six of the untreated infants had no documented recurrences.

Topics: Atrioventricular Node; Cardiac Pacing, Artificial; Digoxin; Electrocardiography; Esophagus; Female; Follow-Up Studies; Heart Atria; Humans; Infant, Newborn; Male; Recurrence; Tachycardia; Time Factors

The clinical features and treatment of atrial flutter in eight infants (four male and four female) less than 2 months of age are presented. Atrial flutter was noted during the first week of life in six of the infants and between 6 and 8 weeks of life in the other two infants. Four of the eight infants had associated structural or functional cardiovascular disease, and in three infants a central venous pressure catheter was present in the atrium at the time atrial flutter was diagnosed. Classic flutter waves were apparent on 12-lead ECGs in only two infants. In six infants, flutter waves were not obvious on standard ECGs, but transesophageal electrogram recordings demonstrated the presence of atrial flutter with second degree atrioventricular block. The atrial cycle length during flutter ranged from 135 to 180 ms (mean 149 ms; mean atrial rate 403 beats per minute); there was a 2:1 ventricular response to atrial flutter. Successful termination of atrial flutter was accomplished using three modes of electrical cardioversion in seven of the eight infants: direct current cardioversion in one, transvenous atrial pacing in one, and transesophageal atrial pacing in five. One asymptomatic infant converted to normal sinus rhythm 24 hours following digoxin administration. One infant had multiple atrial flutter recurrences and required chronic procainamide therapy. In seven of the eight infants, no recurrences have been noted in 6 months to 3 1/2 years of follow-up. These results demonstrate that atrial flutter may be difficult to diagnose in infants with tachycardia unless transesophageal electrogram recording is utilized for evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Atrial Flutter; Cardiac Pacing, Artificial; Combined Modality Therapy; Digoxin; Electric Countershock; Electrocardiography; Female; Humans; Infant; Infant, Newborn; Male; Prenatal Diagnosis; Procainamide; Tachycardia

This study investigated the effects of therapeutic and subtoxic doses of digoxin on the risk of ventricular tachycardia (VT) after graded, transthoracic shocks in anesthetized dogs. A series of direct current shocks (5, 10, 25, 50, 75, 100, 150 and 200 J) was delivered to 33 normal dogs and 6 dogs with a healed (32 +/- 7 days) myocardial infarct (MI). In 10 untreated dogs, the duration of post-shock VT was highly reproducible when 3 separate series of shocks were delivered at 2-hour intervals. In 6 normal dogs treated with oral digoxin (0.5 mg/day for 5 to 7 days), a series of shocks delivered before and during treatment (serum levels 1.5 +/- 0.5 ng/ml) resulted in the same duration of post-shock VT. In 18 normal and 6 dogs with MI, a series of shocks was given before and 90 minutes after a therapeutic dose of digoxin (0.05 mg/kg intravenously). At this dose of digitalis (serum level 2.5 +/- 1.0 ng/ml), there was no difference in the duration of post-shock VT in either normal dogs or dogs with MI. A third series of shocks was given after achieving subtoxic digitalization with additional intravenous digoxin (0.01 mg/kg) every 30 minutes until a premature ventricular stimulus evoked a repetitive ventricular response. The subtoxic doses of digitalis (serum levels 13.9 +/- 4.7 ng/ml) increased the duration of post-shock VT in both normal dogs (100%) and dogs with MI (700%) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Arrhythmias, Cardiac; Digoxin; Dogs; Dose-Response Relationship, Drug; Electric Countershock; Electrocardiography; Heart Ventricles; Myocardial Infarction; Risk; Tachycardia

A 61 year old man with mild aortic stenosis and chronic depression took 12.5 mg digoxin in a suicide attempt. Ventricular tachycardia and fibrillation were resistant to lignocaine and to phenytoin but responded to intravenous amiodarone, with restoration of pacing. Because of persistent hyperkalaemia he was also treated with Fab fragments of digoxin specific antibody, which bound most of the ingested digoxin. It is suggested that the treatment of choice in severe digoxin poisoning is amiodarone for ventricular arrhythmias followed by pacing if necessary and the use of Fab antibody fragments if hyperkalaemia persists.

Topics: Amiodarone; Benzofurans; Digoxin; Electrocardiography; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Tachycardia

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

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

Fetal tachypnea, defined as more than 60 fetal breaths per minute, has been reported to occur almost always in diabetic pregnancies. We treated a patient for fetal tachypnea and tachycardia, the initial presentation of which led to the diagnosis of diabetes mellitus.

Topics: Adult; Digoxin; Echocardiography; Electrocardiography; Female; Fetal Diseases; Humans; Infant, Newborn; Pregnancy; Pregnancy in Diabetics; Quinidine; Respiration Disorders; Tachycardia

We report two patients who developed symptomatic life-threatening ventricular tachyarrhythmias with changing QRS axes (resembling torsades de pointes), during treatment of their supraventricular tachycardias with oral amiodarone. Like other effects of amiodarone on the body, the arrhythmias became evident several days after initiating therapy, at which time electrocardiographic QT prolongation was present. The arrhythmias subsided after amiodarone treatment was withdrawn. No other drugs or electrolyte disturbances could be incriminated as a cause.

Topics: Aged; Amiodarone; Arrhythmias, Cardiac; Atrial Fibrillation; Benzofurans; Digoxin; Electrocardiography; Female; Humans; Tachycardia

Topics: Aged; Digoxin; Humans; Magnesium; Magnesium Deficiency; Magnesium Sulfate; Male; Middle Aged; Myocardium; Potassium; Tachycardia

Intrauterine fetal supraventricular tachycardia is a rare condition often associated with the syndrome of nonimmune hydrops fetalis. When the fetus is preterm it is vital to treat the arrhythmia with maternally administered drugs and different regimens have been reported in the literature. We report 1 case of this arrhythmia successfully treated in utero with maternally administered digoxin resulting in complete reversal of the hydrops fetalis and the birth of a healthy baby. A review of the relevant literature is brought forth.

Topics: Digoxin; Edema; Female; Fetal Diseases; Humans; Pregnancy; Prenatal Diagnosis; Tachycardia

A 75-year-old woman with acute respiratory failure due to pneumonia superimposed on bronchospastic chronic obstructive pulmonary disease and dilated cardiomyopathy developed multifocal and unifocal atrial tachycardia. Arrhythmia recurrence appeared to be dependent on reaching a critical but "nontoxic" serum theophylline concentration in the presence of high normal levels of digoxin. The arrhythmias responded to a decrease in serum theophylline concentration or to the administration of verapamil. The precipitation of the atrial arrhythmias by theophylline in the presence of digitalis, both of which may increase intracellular calcium and a dramatic response to verapamil, which inhibits calcium uptake and release, suggests that these arrhythmias may represent an example of "triggered activity" in man.

Topics: Aged; Digoxin; Electrocardiography; Female; Heart Atria; Humans; Lung Diseases, Obstructive; Recurrence; Tachycardia; Theophylline; Verapamil

Ventricular preexcitation was diagnosed in 6 dogs and 7 cats examined because of weakness, syncope, or congestive heart failure, and as an incidental finding in 1 dog and 2 cats. Reciprocating tachycardias were documented in 8 of the cases. Six of the cats had a pathologic diagnosis of primary cardiomyopathy. Two of the dogs had an associated congenital heart defect. Reciprocating tachycardias were controlled in 4 cases with digoxin, in 2 cases with propranolol, and in 1 case with quinidine. Conduction through the accessory pathway was altered by quinidine (2 cases), digoxin, and propranolol (1 case each), resulting in a lengthened P-R interval and more normal QRS complex configuration.

Topics: Animals; Cat Diseases; Cats; Digoxin; Dog Diseases; Dogs; Electrocardiography; Female; Male; Pre-Excitation Syndromes; Propranolol; Quinidine; Tachycardia

Fetal echocardiographic studies were performed in 2 patients referred for evaluation of cardiac dysrythmias. Supra-ventricular tachycardia were diagnosed in the 2 patients. Appropriate prenatal treatment can not avoid premature deliveries in one case. Evaluation of in utero cardiac arrhythmias and monitoring of in utero therapy are discussed.

Topics: Digoxin; Echocardiography; Female; Humans; Pregnancy; Prenatal Diagnosis; Tachycardia; Verapamil

Topics: Adolescent; Anti-Arrhythmia Agents; Cardiac Complexes, Premature; Child; Child, Preschool; Digoxin; Female; Heart Failure; Humans; Male; Tachycardia

In a fetus with supraventricular tachycardia (SVT) and cardiac failure, normal sinus rhythm (NSR) was restored with maternal digoxin therapy at 26 weeks' gestation. The diagnosis of cardiac failure was based on ultrasound evidence of ascites and scalp edema. Cardiac failure was attributed to the persistent SVT. The infant remained in NSR and was delivered at 36 weeks' gestation because of persistent ascites. Intracardiac anatomy was normal. This case confirms the usefulness of prenatal ultrasound examinations in the diagnosis of fetal SVT and cardiac failure and illustrates the effectiveness and safety of transplacental digoxin therapy in the management of fetal SVT.

Topics: Adult; Ascites; Cesarean Section; Digoxin; Edema; Female; Fetal Diseases; Fetal Heart; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Polyhydramnios; Pregnancy; Tachycardia

The authors report two cases of foetal supra-ventricular tachycardia. They stress the value of two-dimensional ultrasonography in identifying the type of rhythm disorder and the population most likely to benefit from screening for this type of defect.

Topics: Adult; Digoxin; Electrocardiography; Female; Fetal Diseases; Fetal Heart; Fetal Monitoring; Humans; Infant, Newborn; Male; Pregnancy; Prenatal Diagnosis; Tachycardia; Ultrasonography

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

Digoxin has been successfully used to treat fetal supraventricular tachycardia. When therapy with digoxin fails, alternative therapies have met with equivocal success. In this report, successful fetal therapy with maternally administered digoxin and quinidine is presented in three consecutive patients with fetal supraventricular tachycardia. The arrhythmia was eliminated in each instance. Fetal ascites, present in two fetuses, was completely reversed. Intrapartum fetal distress was not observed. The rationale of this therapy and a review of pertinent literature are also presented.

Topics: Administration, Oral; Adolescent; Adult; Ascites; Digoxin; Drug Therapy, Combination; Echocardiography; Female; Fetal Diseases; Humans; Pregnancy; Quinidine; Tachycardia; Wolff-Parkinson-White Syndrome

Intrauterine fetal supraventricular tachycardia (ISVT) is a rare condition which is connected with organic heart disease in only 4-10 per cent. However, neonatally these children develop heart failure in a high frequency (62 per cent). Intrauterine digitalization has been suggested as treatment, especially if the fetus is preterm. Fetal therapeutic concentrations might demand doses inconvenient to the mother. We hereby report one case of intrauterine SVT in the 26th gestational week treated with a standard dose of digoxin resulting in subtherapeutic umbilical digoxin levels. When no consistent influence on fetal heart rate could be seen, verapamil (80 mg x 3) was added to the treatment. A reversion of the tachycardia and the fetal ECG changes was achieved within two days. The verapamil treatment could be withdrawn after ten days, while the digoxin treatment was continued. An initial discrete heart enlargement also was reversed by the treatment. The delivery in gestational week 38 was uneventful and the child did well. A neonatal ECG showed a sinus rythm interfoliated with supraventricular extrasystoles. No signs of organic heart disease have appeared. When last seen at nine months of age, the ECG was normal and digoxin had been discontinued without recurrence of tachycardia.

Topics: Adult; Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Fetal Diseases; Humans; Pregnancy; Tachycardia; Verapamil

In a cooperative, retrospective, study 120 children are reviewed with preexcitation pattern. 80 patients had tachycardias; 54 children were under 1 year, 49 under 3 months of age at their first attack. In 50% the preexcitation pattern disappeared in the first year of life, allthough intermittent preexcitation could be seen in some patients. In 12 patients a circusmovement tachycardia was proved on the surface ecg; in the group of 63 children with a tachycardia of unknown origin probably more may be caused by this mechanism. A beneficial effect of digoxin in childhood is noticed, with good response in 45 cases. A possible explanation for the difference in effect of digoxin during childhood and in adolescence is discussed.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Digoxin; Electrocardiography; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Retrospective Studies; Tachycardia; Wolff-Parkinson-White Syndrome

Perinatal outcome of fetal supraventricular tachycardia. Report of 5 cases and review of the literature. Fetal supraventricular tachycardia (fsVT) is a rare cardiac arrhythmia and is associated with a mortality of 12%. The last decade fsVT has been detected more frequently probably on account of routine fetal monitoring. The outcome of 108 previously reported cases has been reviewed and 5 cases are added. Congestive heart-failure due to fsVT was seen quite frequently. Delivery by caesarean section was performed in 33% of fsVT-cases. Treatment of the condition before and after birth is discussed; digitalis is the drug of choice. A guide-line for delivery is suggested. fsVT should be listed among the possible causes of hydrops foetalis. On request a complete list of references concerning fetal supraventricular tachycardia is available from the authors.

Topics: Digoxin; Edema; Female; Fetal Diseases; Furosemide; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia

Ten patients with refractory recurrent supraventricular tachycardia were found by electrophysiologic study to have bypass tracts and orthodromic atrioventricular reentrant tachycardia. All had failed to respond to conventional antiarrhythmic therapy and were therefore treated with oral amiodarone (1,600 to 2,000 mg/day for 2 weeks, then 800 to 1,200 mg/day for another 2 weeks with subsequent 200 to 600 mg/day maintenance doses). During or after the fourth week of therapy, electrophysiologic study was repeated. In 9 of 10 patients, supraventricular tachycardia could not be reinduced by programmed stimulation. In the remaining patient, nonsustained supraventricular tachycardia (greater than 10 beats, lasting less than 30 seconds) with a slower basic cycle length than that during the control period was provoked. Significant increases in the effective refractory period of the accessory pathway in both the anterograde (+26%, p less than 0.05) and retrograde (+40%, p less than 0.02) directions were noted, the magnitude of change being independent of the control effective refractory period. There were also significant increases in the effective refractory period of the right atrium (+24%, p less than 0.01) and the right ventricle (+15%, p less than 0.01) during long-term therapy with amiodarone. Over a mean follow-up period of 20 months, symptomatic control of the arrhythmia occurred in all patients; in only one patient treatment with amiodarone could not be continued because of side effects. These data establish the electrophysiologic basis for the effectiveness of amiodarone in the prophylactic control of refractory paroxysmal supraventricular tachycardia complicating the bypass tract syndromes.

Topics: Adult; Aged; Amiodarone; Benzofurans; Digoxin; Electrocardiography; Heart Conduction System; Humans; Male; Middle Aged; Propranolol; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Adolescent; Anti-Arrhythmia Agents; Child; Child, Preschool; Digoxin; Electrocardiography; Female; Humans; Infant; Infant, Newborn; Male; Tachycardia; Thiamine Pyrophosphate

Topics: Aged; Digoxin; Electrocardiography; Female; Heart Atria; Humans; Tachycardia

Administration of amiodarone (600 to 1,600 mg/day) to 28 patients during long-term digoxin therapy (0.25 +/- 0.05 mg/day) increased serum digoxin level from 0.97 +/- 0.45 to 1.98 +/- 0.84 ng/ml (p less than 0.001). Gastrointestinal side effects occurred in nine patients, central nervous system reactions occurred in five and cardiovascular reactions occurred in four. Pharmacokinetic studies in six patients with a 1 mg intravenous digoxin dose before and during amiodarone therapy increased serum digoxin level at 30 minutes from 8.59 +/- 1.68 to 10.07 +/- 1.70 ng/ml (p less than 0.05). Amiodarone caused a 31% prolongation of digoxin elimination half-life from 49.5 +/- 8.8 to 65.0 +/- 28.8 hours, but the increase in half-life was not statistically significant. Total body clearance was reduced significantly (29%, p less than 0.05) from 2.05 +/- 0.76 to 1.46 +/- 0.64 ml/min per kg. Nonrenal clearance also showed a significant decrease (33%, p less than 0.05) from 1.20 +/- 0.46 to 0.80 +/- 0.30 ml/min per kg. The renal clearance decreased by 22% and the volume of distribution decreased by 11% after amiodarone therapy, but these changes were not significant. The data show that the mechanism of digoxin-amiodarone interaction is multifactorial and emphasize the need for close monitoring of serum digoxin levels and clinical features during concurrent digoxin-amiodarone therapy.

Topics: Adult; Aged; Amiodarone; Benzofurans; Digoxin; Drug Interactions; Drug Therapy, Combination; Female; Humans; Kinetics; Male; Middle Aged; Tachycardia

A potentially fatal case of massive digitalis intoxication is presented. Recurrent ventricular fibrillation failed to respond to lidocaine or phenytoin, but responded dramatically to magnesium sulfate infusion. A review of the literature and previous clinical studies, as well as the case reported here, appears to indicate that magnesium sulfate given intravenously in adequate quantities (2 to 3 g in one minute followed by 2 g/h for 4 to 5 h) is effective in controlling ventricular irritability caused by toxic levels of digitalis preparations.

Topics: Digoxin; Electrocardiography; Humans; Infusions, Parenteral; Magnesium Sulfate; Male; Middle Aged; Suicide, Attempted; Tachycardia; Ventricular Fibrillation

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

There are a number of important drug interactions with amiodarone. This agent appears to have a marked effect on the kinetics of some commonly used cardiovascular drugs, such as warfarin, digoxin, quinidine, and procainamide, and has dynamic interactions with others, such as the beta blockers and some calcium antagonists. Bleeding has been reported, apparently caused by a potentiation of the anticoagulant effect of warfarin by amiodarone. Torsades de pointes has been observed when quinidine, propafenone, or mexiletine is given together with amiodarone. Furthermore, amiodarone may interact with beta-blocking agents and some of the calcium antagonists to produce symptomatic sinus bradycardia and sinus arrest, especially in a latent or overt sick sinus syndrome. During surgery, amiodarone may induce hypotension and an atropine-resistant bradycardia, possibly by interacting with anesthetic agents. A knowledge of the time of onset, extent, duration, and possible mechanisms of the interactions of amiodarone with other cardioactive drugs is still incomplete, but further studies are of great therapeutic importance.

Topics: Adrenergic beta-Antagonists; Amiodarone; Anti-Arrhythmia Agents; Arrhythmia, Sinus; Benzofurans; Blood Coagulation Disorders; Calcium; Digoxin; Drug Interactions; Drug Synergism; Heart Arrest; Humans; Kinetics; Quinidine; Tachycardia; Warfarin

Amiodarone was administered to 80 patients with recurrent cardiac tachyarrhythmias previously resistant to drug treatment. Forty nine patients were treated for ventricular tachycardia or fibrillation and 31 for supra-ventricular arrhythmias. The mean (range six days to 51 months), permitting a total of 100 patient years of observation. Adverse reactions were observed in 69 patients. Severe side effects were encountered in 13: four patients developed interstitial pneumonitis, four patients developed incessant ventricular tachycardia, three patients taking amiodarone and digoxin sustained sinus node arrest with depression of escape foci, one patient developed hepatitis, and one patient developed hypercalcaemia with renal failure. Furthermore, a rise in the serum concentration of digoxin and potentiation of warfarin anticoagulation occurred in cases in which these agents were combined with amiodarone. Amiodarone was stopped in 14 patients because of side effects. Although amiodarone is effective in suppressing arrhythmias in most patients in whom extensive use of antiarrhythmic drugs has been unsuccessful, it is associated with diverse and serious toxicity. These observations suggest that at present the use of amiodarone should be reserved for patients with life threatening or seriously disabling arrhythmias in whom longer established drugs have been ineffective or are contraindicated.

Topics: Adult; Aged; Amiodarone; Arrhythmias, Cardiac; Benzofurans; Digoxin; Drug Interactions; Female; Humans; Male; Middle Aged; Pulmonary Fibrosis; Recurrence; Respiratory Function Tests; Tachycardia

Electrophysiologic studies with programmed cardiac stimulation were performed in a selected group of 17 patients with severe proximal coronary artery disease involving at least 2 major vessels and left ventricular ejection fractions greater than 30% who were undergoing coronary artery bypass graft surgery after prehospital cardiac arrest or ventricular tachycardia (VT) unassociated with acute myocardial infarction. Before surgery and without antiarrhythmic drug therapy, programmed cardiac stimulation induced ventricular fibrillation (VF) in 4 patients, and VT (greater than or equal to 5 beats) in 11 patients. Inducible VT or VF was suppressed by antiarrhythmic drugs in 7 of 13 patients in whom they were tried. Patients underwent coronary artery bypass graft surgery unassociated with perioperative myocardial infarction. When studied again an average of 19 days after surgery, 10 patients had no inducible VT or VF without antiarrhythmic drug therapy; 6 had induced VT. One patient had spontaneous VT. An effective antiarrhythmic regimen that suppressed inducible or spontaneous VT, or both, was defined by serial electrophysiologic studies in 4 patients, whereas 3 patients continued to manifest electrically inducible VT with all antiarrhythmic regimens tested. All but 1 patient, in whom postoperative VT could not be suppressed, are free of arrhythmias after a mean follow-up period of 23 months (range 6 to 53). It is concluded that myocardial revascularization alone may improve the abnormal electrophysiologic findings in certain patients; however, this effect of coronary artery bypass graft surgery is unpredictable, and pre- and postoperative electrophysiologic studies are recommended as part of the evaluation of these patients.

Topics: Aged; Amiodarone; Cardiac Pacing, Artificial; Coronary Artery Bypass; Digoxin; Electrophysiology; Female; Heart Ventricles; Humans; Male; Middle Aged; Postoperative Care; Preoperative Care; Radiography; Tachycardia; Ventricular Fibrillation

Preexisting anomalies of impulse formation and conduction, cardiac failure, myocardial ischemia and abnormal peripheral vasoregulation predispose the elderly patient to frequent and often severe side-effects of antiarrhythmic drugs. Paroxysmal supraventricular tachycardia in patients with sick sinus syndrome can be especially difficult to treat, as most antiarrhythmics further prolong the sinus node recovery time. Thus, implantation of a pacemaker is often necessary to prevent symptomatic bradycardia. Concomitant treatment with diuretics or digitalis also increases the risk of drug induced ventricular dysrhythmias. Interaction between quinidine, verapamil, amiodarone and digoxin may be the reason for drug toxicity. To compensate for decreased renal or metabolic drug clearances antiarrhythmic treatment in elderly patients should be initiated with lower doses than usual.

Topics: Aged; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bradycardia; Digoxin; Heart Ventricles; Hemodynamics; Humans; Kidney Function Tests; Liver Function Tests; Metabolic Clearance Rate; Risk; Tachycardia

We studied the direct effects of digitalis on sinoatrial conduction time (SACT), atrial rate (AR) and developed tension (DT) in isolated atrial muscle, using an isolated dog atrial preparation perfused with heparinized blood from the carotid artery of an anesthetized donor dog. After digoxin or deslanoside (100 micrograms or 200 micrograms/Kg) was given intravenously to the donor dog, SACT, AR and DT of the isolated atrium were continuously measured. Following administration of 100 micrograms/Kg of digoxin, an immediate sinus bradycardia followed by various kinds of ventricular arrhythmias was observed in the donor dog, and the DT of the isolated atrium was augmented without any effects on the SACT and AR in all 3 experiments. With 200 micrograms/Kg of digoxin or deslanoside, ventricular fibrillation was induced in all 5 donor dogs within 75 min after digitalis administration. In these cases, the DT of the isolated atrium was immediately increased to over 200% of control DT, but SACT and AR were not affected until 20 min later, at which time increases in SACT and AR were finally induced. From these results, it is concluded that a large amount of digitalis has no distinct direct effect on SA nodal pacemaker activity and SA conductivity. Moreover, extremely large doses of digitalis which cause ventricular fibrillation might also induce a prolongation of SACT in addition to sinus tachycardia.

Topics: Animals; Bradycardia; Deslanoside; Digoxin; Dogs; Dose-Response Relationship, Drug; Heart Atria; Heart Rate; Lanatosides; Myocardial Contraction; Perfusion; Sinoatrial Node; Tachycardia

Topics: Adult; Animals; Digoxin; Dogs; Female; Fetal Diseases; Heart Failure; Humans; Infant, Newborn; Pregnancy; Prenatal Diagnosis; Propranolol; Tachycardia; Ultrasonography; Verapamil

A clinical investigation was carried out in 13 patients in order to answer the question of a possible interaction between amiodarone (A) and digoxin (D) and to study the extent to which plasma digoxin levels (PDL) may be influenced by A. Combined therapy with A + D was instituted in patients with supraventricular tachyarrhythmia where treatment with D alone was insufficient. All patients had normal renal function. Amiodarone was added to the treatment regimen of patients receiving D at doses ranging from 0.125 to 0.5 mg daily on a long term basis. The initial dosage of A was 1200 mg daily for 5 days to achieve saturation, followed by a maintenance dose of 200-400 mg daily. 3 PDL were measured before therapy with A was added and during combined A and D treatment at weeks 1, 2 and 3 and 3 months after the addition of A. In 11 patients a significant increase in PDL occurred as early as the 1st and 2nd weeks following the addition of A. In one patient PDL was elevated only after 3 months and in one other patient it remained unchanged. In 4 patients the PDL increase was associated with nausea. No other subjective or objective symptoms of digitalis intoxication were observed. This investigation has demonstrated a clinically relevant interaction between A and D. Regular monitoring of PDL is recommended during the first 3 weeks of combined treatment with A + D, and the D doses should be adjusted accordingly.

Topics: Adult; Aged; Amiodarone; Benzofurans; Digoxin; Drug Interactions; Female; Humans; Male; Middle Aged; Tachycardia

Topics: Aged; Digoxin; Electrocardiography; Female; Heart Valve Diseases; Humans; Male; Medigoxin; Middle Aged; Mitral Valve; Myocardial Infarction; Tachycardia; Time Factors

Topics: Atrial Fibrillation; Digoxin; Electrocardiography; Heart Atria; Heart Ventricles; Humans; Male; Middle Aged; Tachycardia

Seven patients with congestive heart failure receiving long-term diuretic treatment (more than three years) experienced idionodal tachycardia in the presence of apparently normal serum digoxin levels. Intravenous bolus administration of magnesium (Mg) sulfate, followed by intramuscular Mg repletion, abolished the digitalis-toxic arrhythmia. The finding of decreased lymphocyte Mg and potassium contents proved the existence of cellular Mg depletion associated with normal serum Mg levels in five patients and with hypomagnesemia in the other two. Decreased cellular Mg content with normal serum Mg level predisposes to digitalis-toxic arrhythmias.

Topics: Aged; Digoxin; Heart Failure; Humans; Lymph Nodes; Magnesium; Magnesium Deficiency; Magnesium Sulfate; Male; Middle Aged; Tachycardia

After noting bradycardia-induced supraventricular tachycardia (SVT) in two successive children with SVT, we analyzed Holter monitor recordings done on 66 children with suspected or proved SVT. Ten children had apparent reentry SVT. The most common mode of initiation (eight of 10 patients) was not premature atrial beats, but sudden sinus pause with a junctional escape beat (JEB), usually fused with the delayed sinus P wave, initiating the tachycardia. Electrophysiologic studies in five children who had this mode of initiation showed evidence of reentry in four, possibly by dual atrioventricular nodal (AVN) pathways. Since sudden sinus pause and JEB are relatively uncommon in adults, the disappearance of this phenomenon with age may be the most significant reason why children often have less tachyarrhythmia as they get older. Both propranolol and digoxin significantly increased the numbers of episodes of SVT in the three patients tested with serial Holter monitoring.

Topics: Adolescent; Atrioventricular Node; Bradycardia; Cardiac Pacing, Artificial; Child; Child, Preschool; Digoxin; Electrocardiography; Humans; Propranolol; Tachycardia

Topics: Amiodarone; Benzofurans; Digoxin; Drug Interactions; Humans; Tachycardia

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

Five patients with recurrent syncope or pre-syncope due to rapid supraventricular tachycardias underwent electrophysiological study. In each patient, an AV nodal re-entrant tachycardia could be induced. By leaving a coronary sinus catheter in place, the effects of drugs on the ability to induce tachycardia could be tested on sequential days. Drug effects were highly variable, but in each patient it was possible to determine a drug which prevented induction of tachycardia. Patients treated with this drug have had no recurrent symptoms or tachycardias with a followup of 4-21 months. Although AV nodal re-entry is highly dependent on autonomic tone, electrophysiological study appears to be a useful means of selecting therapy in patients with severe, symptomatic tachycardias.

Topics: Adult; Atrioventricular Node; Cardiac Pacing, Artificial; Digoxin; Electrocardiography; Female; Humans; Propranolol; Syncope; Tachycardia

Atrial synchronous pacemakers have been known to cause a variety of cardiac arrhythmias. Of particular concern are those arrhythmias involving a pacemaker stimulus occurring on a T wave, because these may lead to ventricular tachycardia. The Medtronic 2409 ASVIP pacemaker is an atrial synchronous pacemaker with several features designed to decrease the likelihood of such arrhythmias. We report a patient in whom a normally functioning Medtronic 2409 ASVIP pacemaker, despite these features, induced recurrent ventricular tachycardia. Conditions which predisposed this patient to pacemaker-induced re-entrant arrhythmias are discussed.

Topics: Digoxin; Electric Countershock; Electrophysiology; Female; Heart Block; Heart Failure; Heart Ventricles; Humans; Middle Aged; Myocardial Infarction; Pacemaker, Artificial; Procainamide; Tachycardia

Most recent studies discussing tachycardias with alternating QRS polarity have referred to those known as torsade de pointes. This report, in contrast, deals with bidirectional tachycardia and the effects of lignocaine on 10 patients with this arrhythmia. Three of the patients also had digitalis-induced atrial tachycardia with block. In one patient, a single bolus of lignocaine was followed (five minutes later) by ventricular fibrillation, but the other nine patients received two boluses of 75 mg followed by a drip infusion of 3 mg/min. The drug terminated the episodes of atrial tachycardia with block and bidirectional tachycardia in all patients thus treated. Whereas the abolition of the bidirectional tachycardia was permanent in the seven patients with digitalis intoxication, it recurred after stopping the drip infusion in the two patients without digitalis toxicity. It is concluded that lignocaine can be useful in the treatment of digitalis-induced bidirectional tachycardia and atrial tachycardia with block. From this study no conclusions can be drawn, however, as to whether lignocaine is superior to other class I or class IV agents.

Topics: Adult; Aged; Digoxin; Drug Administration Schedule; Female; Heart Block; Humans; Infusions, Parenteral; Lidocaine; Male; Middle Aged; Tachycardia

Topics: Animals; Bradycardia; Brain; Digoxin; Dogs; Female; Heart Rate; Male; Receptors, Cholinergic; Receptors, Histamine; Tachycardia

In 22 patients with atrioventricular reentrant tachycardia incorporating a retrogradely conducting accessory pathway, electrophysiologic studies were done before and after oral digoxin, 1.25 mg, and propranolol, 160 to 240 mg, each given in 4 divided doses at 6-hour intervals. Before digoxin and propranolol, all 22 patients had induction of sustained tachycardia. After the medication six patients lost the ability to induce atrial echo and one lost the ability to sustain tachycardia due to an increased retrograde accessory pathway or atrial refractoriness or both. Six patients lost the ability to induce or sustain tachycardia due to increased atrioventricular nodal refractoriness. In the remaining nine patients with inducible sustained tachycardia, cycle lengths of tachycardia were prolonged. These findings suggest that combined use of oral digoxin and propranolol is useful in selected patients with atrioventricular reentrant tachycardia.

Topics: Adolescent; Adult; Aged; Digoxin; Drug Therapy, Combination; Female; Heart Conduction System; Heart Function Tests; Humans; Male; Middle Aged; Propranolol; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digoxin; Electric Countershock; Female; Heart Diseases; Humans; Male; Middle Aged; Tachycardia

Topics: Digoxin; Echocardiography; Female; Fetal Diseases; Fetal Heart; Humans; Infant, Newborn; Injections, Intravenous; Maternal-Fetal Exchange; Pregnancy; Procainamide; Propranolol; Tachycardia

Intrauterine supraventricular tachycardia is an uncommon cardiac arrhythmia that presents difficult problems in diagnosis and management, especially in the very preterm infant. Serial ultrasound examinations were used to follow the course of fetal ascites and the maternal administration of digoxin to induce cardioversion. Higher maternal doses of digoxin than administered to the nonpregnant patient may be necessary to achieve adequate digitalization of the fetus. As many infants with supraventricular tachycardia require continued medical management, they should be delivered in a facility with neonatal intensive care capabilities.

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

A 3 1/2-year-old child with incessant supraventricular tachycardia was investigated with intravenous vago-mimetic drugs, which had unexpected beneficial results. These observations suggested selection of digitalis as the antiarrhythmic drug, which would not otherwise have been chosen. The potential advantages of non-invasive, acute autonomic modulation for optimal drug selection in children with arrhythmias are illustrated by this case.

Topics: Child; Chronic Disease; Digoxin; Electrocardiography; Humans; Male; Tachycardia

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Carotid Sinus; Digoxin; Electric Countershock; Heart Rate; Humans; Massage; Tachycardia; Verapamil

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atropine; Bradycardia; Cardiac Complexes, Premature; Digoxin; Heart Block; Heart Failure; Humans; Lidocaine; Myocardial Infarction; Propranolol; Tachycardia

While the principles of drug management of supraventricular tachyarrhythmias have remained essentially unchanged, such treatment remains empirical in many patients. Recent advances in the understanding of electrophysiological mechanisms have not only rationalised treatment but dictated newer approaches to these and other arrhythmias.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Electric Countershock; Electrocardiography; Exercise Test; Heart Ventricles; Humans; Pacemaker, Artificial; Procainamide; Propranolol; Quinidine; Tachycardia

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

Certain arrhythmias detected on the electrocardiogram are considered to be reliable indicators of digitalis intoxication. We have evaluated the incidence of these arrhythmias on 24-hour electrocardiographic monitoring (Holter monitoring) in 69 consecutive patients who had serum levels of digoxin determined within 24 hours of the onset of continuous electrocardiographic monitoring. According to teh serum level of digoxin, the patients were divided into the following three groups: (1) group 1 had 0 to 1.0 ng/ml (31 patients); (2) group 2 had 1.1 to 2.0 ng/ml (27 patients); and group 3 had greater than or equal to 2.1 ng/ml (11 patients). The following arrhythmias were considered to reflect digitalis-provoked arrhythmias: (1) persistent sinus bradycardia or sinus pauses (or both); (2) atrioventricular block; (3) paroxysmal atrial tachycardia with block; (4) accelerated junction rhythm; (5) complex ventricular arrhythmias (multifocal ventricular premature beats, bigeminy and trigeminy, and pairs); and (6) ventricular tachycardia. There was no significant difference in the incidence of these six categories of arrhythmias among the three groups. In addition, there was no significant difference in the mean serum level of digoxin for patients with and without the arrhythmias within each category. Ten of the 69 patients had combinations of three of the so-called digitalis-provoked arrhythmias, with incidences among the three groups showing no significant differences. In conclusion, rhythms considered to be potentially due to digitalis intoxication are frequently observed in hospitalized patients undergoing 24-hour electrocardiographic monitoring, are frequently unrelated to the serum level of digoxin, and appear unlikely to reflect true digitalis intoxication in many of these patients.

Topics: Aged; Arrhythmias, Cardiac; Bradycardia; Digoxin; Electrocardiography; Heart Block; Humans; Monitoring, Physiologic; Retrospective Studies; Tachycardia

We reviewed the records of 217 children whose first episode of supraventricular tachycardia occurred before 18 years (median age 24 months). There were 112 males and 105 females. Of the 49 with congenital heart disease, SVT began before any operation in 26 and greater than 2 weeks postoperatively in 23. Wolf-Parkinson-White syndrome was present on surface ECG in 47/217 (22%). Congestive heart failure accompanied the first episode of SVT in 38% of the patients who were 4 months of age or younger, and in only 19% of those over 4 months (P less than 0.001). Treatment was successful in stopping SVT within 48 hours in 90/142 (63%). Successful short-term treatment included digoxin 57/184 (68%), cardioversion 12/20 (60%), vagal maneuvers 12/19 (63%), phenylephrine 3/9, and overdrive pacing 4/5. SVT recurred at least once in 83% of all patients. On follow-up (mean 4.6 years), episodes of SVT were still present in 56%. Three patients died--two from incessant SVT and one from a CVA after VSD repair. We conclude that long-term status was difficult to predict, but SVT was present in fewer patients whose age at onset was less than 4 months and in those with unoperated CHD. Early recurrence was not a poor prognostic sign. We recommended treatment for at least one year in all patients with SVT, whether or not the first episode terminates spontaneously.

Topics: Adolescent; Anti-Arrhythmia Agents; Child; Child, Preschool; Digoxin; Female; Follow-Up Studies; Heart Failure; Humans; Infant; Infant, Newborn; Male; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Adult; Digoxin; Female; Fetal Diseases; Fetal Monitoring; Gestational Age; Heart Failure; Humans; Maternal-Fetal Exchange; Pregnancy; Tachycardia

Topics: Aged; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Tachycardia

Topics: Aging; Child, Preschool; Digoxin; Electrocardiography; Female; Humans; Infant; Male; Recurrence; Tachycardia

In a 90-year-old man undergoing prolonged digitalis therapy, digitalis toxicity was precipitated by the administration of quinidine. The electrocardiogram revealed supraventricular bidirectional tachycardia, a rare but characteristic arrhythmia associated with digitalis toxicity. Upon withdrawal of digoxin, the clinical and ECG signs disappeared. A diagnosis of digitalis toxicity rather than quinidine intolerance led to appropriate treatment.

Topics: Aged; Digoxin; Drug Interactions; Electrocardiography; Humans; Male; Quinidine; Tachycardia

Ten cases of chaotic atrial tachycardia (CAT) in childhood are reported. Patients' ages ranged from 1 day to 18 years (average, 3.5 years) at the time of diagnosis. The patients were divided into groups according to the following criteria: (1) no cardiac disease (n = 5), (2) congenital heart disease (n = 4), and (3) acquired heart disease (n = 1). Nine of the children were treated with digoxin; however, it appears there was no beneficial effect. In fact, the single death in our study group may have been attributable to digitalis intoxication. No children have had recurrence of the arrhythmia after discontinuation of the drug. The duration of the tachyarrhythmia was extremely variable; however, CAT was well tolerated and was self-limiting in our patients.

Topics: Adolescent; Arrhythmias, Cardiac; Child; Child, Preschool; Chronic Disease; Digoxin; Electrocardiography; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Propranolol; Quinidine; Rheumatic Heart Disease; Tachycardia

Intrauterine congestive heart-failure caused by a supraventricular tachyarrhythmia was diagnosed in a fetus at 29-30 weeks' gestation. Major congenital malformations were excluded by sonography, amniocentesis, and fetal abdominal paracentesis, and those of the heart by intrauterine fetal echocardiography. The mother was given digoxin and the fetal tachycardia converted to sinus rhythm.

Topics: Adult; Digoxin; Female; Fetal Diseases; Fetal Heart; Heart Failure; Humans; Infant, Newborn; Male; Methods; Pregnancy; Pregnancy Trimester, Third; Tachycardia

Topics: Adolescent; Adult; Cardiac Catheterization; Child; Child, Preschool; Digoxin; Echocardiography; Electrocardiography; Exercise Test; Female; Follow-Up Studies; Heart Murmurs; Humans; Long-Term Care; Male; Mitral Valve Prolapse; Quinidine; Tachycardia

In animal experiments heterologous digoxin-specific F(ab')2 antibody fragments have been found to be effective for the treatment of arrhythmias induced by toxic doses of digoxin. So far they have been successfully employed in three patients suffering from digoxin poisoning. The present study was undertaken to test whether these antibodies are also effective in the treatment of digitoxin poisoning. Ventricular tachycardia, induced in digitalized cats by intravenous injections of digitoxin, was fatal in four out of five controls. However, sinus rhythm was reinstated in all the animals treated with digoxin-specific F(ab')2 after onset of the arrhythmia. Cross-reactivity between the antibodies used and digitoxin, while slight in vitro, is, nevertheless, sufficient to justify their clinical use in cases of digitoxin poisoning.

Topics: Animals; Antibodies; Antibody Specificity; Cats; Cross Reactions; Digitoxin; Digoxin; Female; Immunoglobulin Fab Fragments; Male; Tachycardia

In an attempt to prevent recurrent reentrant supraventricular tachycardia, an experimentally designed new pacemaker has been developed. The pacemaker, when connected to both atrial and ventricular electrodes, is capable of sensing either an atrial or ventricular signal and, in turn, triggers simultaneous atrioventricular A-V) stimulation. Efficacy of this pacemake was tested in four patients with recurrent paroxysmal A-V nodal reentrant tachycardia during electrophysiologic studies. After connection of the electrodes to the new pacemaker, all atrial or ventricular premature stimuli elicited simultaneous A-V stimulation with resultant impulse collision in the A-V junction. Consequently, the reentrant tachycardia zone was completely abolished in all patients. This study has thus demonstrated the clinical feasibility of simultaneous A-V pacing to abolish the supraventricular tachycardia zone in man.

Topics: Adult; Atrioventricular Node; Cardiac Pacing, Artificial; Digoxin; Electrodes; Electrophysiology; Female; Follow-Up Studies; Heart Conduction System; Heart Ventricles; Humans; Male; Middle Aged; Propranolol; Quinidine; Tachycardia; Time Factors; Verapamil

Topics: Digoxin; Electrocardiography; Heart Atria; Heart Ventricles; Humans; Male; Middle Aged; Tachycardia

Topics: Acute Disease; Coronary Disease; Digoxin; Humans; Lidocaine; Tachycardia; Ventricular Fibrillation

Topics: Aged; Anti-Arrhythmia Agents; Cardiac Glycosides; Coronary Disease; Digoxin; Drug Interactions; Humans; Male; Quinidine; Tachycardia

A variety of atrial dysrhythmias including paroxysmal atrial tachycardia, atrial tachycardia with 2nd-grade atrioventricular block, atrial fibrillation, and atrial flutter developed in a 5-year-old Quarter Horse gelding. Quinidine and propranolol were not successful in restoring normal sinus rhythm. Sinus rhythm was re-established during digoxin therapy, but later reverted to atrial dysrhythmia. At necropsy, multiple, discrete pale areas were found on both atria and the interatrial myocardium. Histologic examination of these lesions demonstrated myocytolysis and replacement by fibrous connective tissue.

Topics: Animals; Arrhythmias, Cardiac; Digoxin; Electrocardiography; Heart Atria; Horse Diseases; Horses; Male; Tachycardia

Topics: Adult; Aged; Diastole; Digoxin; Electrocardiography; Female; Humans; Male; Middle Aged; Quinidine; Tachycardia; Ventricular Fibrillation

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

Carotid sinus massage affects supraventricular arrhythmias primarily through vagotonic effects on the sinus and AV nodes, but vagal innervation of the ventricle also exists and has been shown to have functional significance. The case presented here illustrates an unusual example of a ventricular tachycardia that was repeatedly converted to normal sinus rhythm by carotid sinus massage following administration of digoxin. The clinician should be aware that a wide QRS-complex tachycardia that responds to carotid sinus massage is not necessarily supraventricular in origin.

Topics: Carotid Sinus; Digoxin; Female; Heart Ventricles; Humans; Massage; Middle Aged; Tachycardia; Vagus Nerve

Six examples of intrauterine supraventricular tachycardia together with 31 previously reported cases are described and analyzed. Among the 37 infants, structural heart disease was present in only four (11%), three of whom died. Males comprised 68% of the group without identifiable heart disease or pre-excitation. Congestive heart failure was evident in 62% of the infants at birth or shortly thereafter; ascites was the predominant finding in three (8%). Neither the duration of SVT nor heart rate was predictive of the clinical status at birth. Infants without underlying heart disease or conduction abnormalities had a benign course after the neonatal period. Thirty-eight percent of the babies converted to sinus rhythm during or shortly after delivery without medication, and most of the others converted after digitalization. The failure of maternal digitalization to convert SVT to sinus rhythm in two of our infants was perhaps related to subtherapeutic maternal and fetal digoxin levels. Newborn infants presenting with unexplained ascites or congestive heart failure should have an ECG to determine whether pre-excitation is present, and their cardiac rhythm should be monitored for several days.

Topics: Ascites; Cardiomegaly; Digoxin; Female; Fetal Diseases; Heart Defects, Congenital; Heart Failure; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia

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

Topics: Ascites; Digoxin; Edrophonium; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Pregnancy; Propranolol; Tachycardia

Topics: Atrioventricular Node; Bundle of His; Cardiac Catheterization; Cardiac Surgical Procedures; Digoxin; Electrocardiography; Electrophysiology; Follow-Up Studies; Heart Ventricles; Hemodynamics; Humans; Infant; Infant, Newborn; Phenytoin; Propranolol; Reserpine; Tachycardia

Twenty-five patients with recent or old myocardial infarction were studied because they had life-threatening ventricular arrhythmias that required repeated cardioversions and were intractable to medical management. All patients had had a large anterior infarction a mean of 4.6 weeks before the emergence of the arrhythmias and all had severe left ventricular dysfunction. Cardiac catheterization or autopsy revealed a left ventricular aneurysm in 18 of 18 patients and obstruction of the left anterior descending coronary artery in 20 of 20 patients. Of 16 patients treated surgically with aneurysm resection or coronary bypass grafting, or both, 10 (62 percent) were alive after 3 to 39 (mean 26) months of follow-up. The perioperative mortality rate was 31 percent and only one patient died during the postoperative follow-up period 4 months after discharge from the hospital. By contrast, all nine medically treated patients died either in the hospital (four patients) or suddenly within 2 months of discharge (five patients). Ventricular fibrillation was documented as the cause of death in five of these patients. Surgical intervention was found to improve significantly the survival of these patients (P less than 0.02). The perioperative mortality rate was lower when at least 4 weeks had elapsed from acute infarction to surgery (10 versus 67 percent) and when the procedure included coronary bypass grafting (13 versus 50 percent), although these differences were not statistically significant (P greater than 0.05).

Topics: Adult; Aged; Anti-Arrhythmia Agents; Cardiac Pacing, Artificial; Coronary Angiography; Digoxin; Diuretics; Electric Countershock; Female; Heart Aneurysm; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Tachycardia

A patient with alternating atrial and ventricular tachycardia is described. He had an acute myocardial infarction and was taking digitalis. The atrial tachycardia, which was occasionally associated with aberrant ventricular conduction, was able to interrupt the ventricular tachycardia though the reverse was not true, suggesting a retrograde conduction block. This patient shows that atrial and ventricular arrhythmias can alternate and, since tachycardia with aberrant ventricular conduction can closely resemble ventricular tachycardia, intra-atrial electrocardiography may be necessary to establish an accurate diagnosis.

Topics: Digoxin; Electrocardiography; Heart Atria; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Tachycardia

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

Atrioventricular nodal alternating Wenckebach periods were defined as episodes of 2:1 atrioventricular block in which there was a gradual increase in transmission intervals of conducted beats ending in two or three consecutively blocked atrial impulses. This is one of the mechanisms whereby 2:1 atrioventricular block progresses into 3:1 or 4:1 atrioventricular block. Alternating Wenckebach periods appear during rapid atrial pac,ng (even in the absence of depressed atrioventricular nodal function), provided that the atria can be captured at a rate fast enough to allow for the occurrence of this phenomenon. Treatment of atrial flutter with digoxin and quinidine produces alternating Wenckebach's periods, with associated electrocardiographic changes specific for the type of drug given. In patients with "atrial tachycardia with atrioventricular block" due to digitalis intoxication or with primary disease of the conducting system or with acute myocardial infarction, there are coexisting severe arrhythmias and clinical symptoms requiring almost immediate pharmacologic or electrical therapy. We conclude that atrioventricular nodal alternating Wenckebach's periods are common and frequentyly transient and that they occur in a variety of clinical conditions, most of which are benign; however, contrary to what is commonly accepted, some episodes appear in clinical settings requiring prompt pharmacologic or electrical treatment.

Topics: Acute Disease; Atrial Flutter; Atrioventricular Node; Bundle of His; Digitalis Glycosides; Digoxin; Electrocardiography; Heart Atria; Heart Block; Heart Conduction System; Heart Diseases; Humans; Myocardial Infarction; Pacemaker, Artificial; Purkinje Fibers; Quinidine; Tachycardia

A 66-year-old white woman with a greater than 20-year history of electrocardiographic evidence of the Wolff-Parkinson-White syndrome, including documented recurrent supraventricular tachycardias, was studied. Despite the disappearance of the delta wave after initiation of therapy with digoxin and quinidine sulfate, the patient continued to have frequent episodes of supraventricular tachycardia. At a time when the serum levels of digoxin and quinidine were in the therapeutic range, extensive electrophysiologic studies were performed. Supraventricular tachycardia at a rate of 160 beats per minute was initiated by induced atrial premature depolarizations. The circuit of tachycardia involved anterograde conduction through the pathway of the atrioventricular node and His bundle and retrograde conduction through the bypass tract. We concluded that elimination of the delta wave and other electrocardiographic characteristics of the Wolff-Parkinson-White syndrome cannot be relied upon to indicate successful pharmacologic prophylaxis for induction of tachyarrhythmia associated with this syndrome.

Topics: Aged; Atrioventricular Node; Bundle of His; Cardiac Pacing, Artificial; Digoxin; Electrocardiography; Female; Humans; Quinidine; Tachycardia; Wolff-Parkinson-White Syndrome

The prolonged QT interval syndrome without hearing loss (Romano-Ward syndrome) is described in three families with 48 affected members. Syncope or dizziness caused by different ventricular tachyarrhythmias were the presenting symptoms in the symptomatic patients. Four of the subjects died suddenly. Right stellate ganglionectomy was performed in one patient in order to abolish the ventricular dysrhythmia. beta-blockers are considered the drug of choice in patients with hereditary prolonged QT interval; if the beta-blockers fail to abolish the syncopal attacks of severe bradycardia complicates the clinical course, a pharmacological blockade of the stellate ganglia should be performed and its results carefully evaluated in order to establish whether a stellate ganglionectomy is justified.

Topics: Adult; Arrhythmias, Cardiac; Child; Digoxin; Female; Humans; Isoproterenol; Male; Pedigree; Propranolol; Syndrome; Tachycardia

Four cases of intra-uterine ectopic supraventricular tachycardia are described. In three there were none or only minor symptoms immediately after delivery and subsequently. The fourth baby having a congenital W-P-W-syndrome was born with severe hydrops fetalis and was asphyxiated. From these cases and from data reported in the literature it is concluded that intra-uterine heart failure is a significant risk when the fetal heart rate persistently exceeds 230 per minute. It is suggested that digoxin administered to the mother may be beneficial to the fetus in cases of intra-uterine ectopic tachycardia.

Topics: Apgar Score; Digoxin; Female; Fetal Diseases; Heart Rate; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia

Topics: Cardiac Pacing, Artificial; Digoxin; Electric Stimulation; Electrophysiology; Humans; Medigoxin; Pacemaker, Artificial; Tachycardia; Ventricular Function

The serum-digoxin level was measured by radio-immunoassay (Immutope) on 245 patients in a coronary care unit. Cardiac arrhythmias were assumed to be digoxin-induced if they disappeared after the drug had been stopped. Patients who had received digitoxin or spironolactone were excluded. The results indicated a normal digoxin range of 1.52 +/- 0.2 ng/ml and a toxic one of 2.78 +/- 0.38 ng/ml. First degree A-V block, atrial ectopic beats and ventricular ectopics with variable coupling intervals were frequently associated with serum-digoxin levels of 1.5-2.5 ng/ml, while higher grade A-V block, atrial tachycardia, bigeminy and atrial tachycardia with block were more frequent with higher serum-digoxin levels (greater than 3.0 ng/ml). Atrial arrhythmias were especially frequent with serum levels above 3.0 ng/ml. This suggests different sensitivities of atrial and ventricular myocardium. Atrial arrhythmias thus in general indicate a higher degree of toxicity at high serum levels, while ventricular ectopic beats occur both with high serum levels and also with increased digoxin sensitivity of the ventricles.

Topics: Arrhythmias, Cardiac; Cardiac Complexes, Premature; Coronary Disease; Digoxin; Heart Block; Humans; Radioimmunoassay; Reference Values; Tachycardia

The place of pacemakers in the treatment of tachyarrhythmias has expanded far beyond the initial role in the brady-tachy syndrome, of providing a "minimum guaranteed rate" while medications suppress the tachycardia. Techniques have been developed for prevention, termination, and duplication of a patient's spontaneous tachycardia under safe catheterization laboratory conditions. Combined with accumulating information about the normal responses to electrophysiologic stresses, these techniques have led to a new dimension in arrhythmia control. Most tachycardias previously felt to be refractory can be controlled after serial electrophysiologic-pharmacologic testing, during which sequential pharmacologic and pacer regimens are tested until a combination is found which prevents induction of tachycardias, and/or a pace mode is found which reliably terminates the tachycardia. Use of such an approach reduces hospital admissions and referral for surgery, and eliminates prolonged hospitalization for assessment of therapy in patients with infrequent but potentially lethal spontaneous tachycardias.

Topics: Adolescent; Adult; Aged; Anti-Arrhythmia Agents; Bretylium Compounds; Cardiac Complexes, Premature; Digoxin; Edrophonium; Electrocardiography; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Pacemaker, Artificial; Phenytoin; Procainamide; Propantheline; Propranolol; Pyridostigmine Bromide; Quinidine; Recurrence; Tachycardia

This case report describes a 64-year-old woman with a cardiomyopathy and associated fascicular conduction disturbances partly related to digitalis therapy. Electrocardiograms showed incomplete left bundle branch block with left anterior hemiblock the latter, consistently changing in pattern and rhythm as in bidirectional tachycardia but at a relatively normal heart rate. The relationship of severe myocardial disease to the apparent likelihood of pre-existing depression of fascicular conduction in cases of bidirectional tachycardia precipitated by digitalis, is exemplified.

Topics: Bundle-Branch Block; Digoxin; Electrocardiography; Female; Heart Block; Heart Conduction System; Humans; Middle Aged; Tachycardia

Topics: Adenosine Triphosphatases; Animals; Digoxin; Dogs; Glucose; Hypokalemia; Insulin; Tachycardia

A novel benzanilide derivative, MJ 9067, has been shown to abolish experimental atrial and ventricular arrhythmiase effectively and promote the return of normal sinus rhythm in a variety of animal models. At intravenous dose levels ranging from 0.5 to 3.2 mg/kg, MJ 9067 successfully converted atrial fibrillation induced by either local application of aconitine or electrical stimulation, and ventricular tachycardia elicited by intravenous injection of ouabain or digoxin. The compound was equally effective in vagotomized or nonvagotomized dogs, and in intact cats and monkeys. The ventricular ectopic rate in conscious dogs 18 to 20 hours after two-stage ligation of a coronary artery was also markedly reduced by the drug at 2 mg/kg i.v. At antiarrhythmic dose levels, there were no undesirable effects noted on peripheral blood pressure, heart rate or the configuration of the electrocardiogram.

Topics: Aconitine; Anilides; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Blood Pressure; Cats; Digoxin; Dogs; Electric Stimulation; Electrocardiography; Female; Haplorhini; Heart Rate; Male; Ouabain; Piperidines; Saimiri; Tachycardia

This report describes the case of a patient with a supraventricular tachycardia with a ventricular rate of 109/min and no visible P waves in the electrocardiogram. The recording of the monophasic action potential of the right atrium disclosed an atrial tachycardia with a rate of 218/min. There was an alternans of the phase 2 of repolarisation in the action potential. This report emphasises the fact that the phenomenon of alternans occurs in man, as in the experimental animal, at a cellular level.

Topics: Action Potentials; Aged; Atrial Fibrillation; Digoxin; Heart Atria; Heart Block; Humans; Male; Tachycardia

Attempts to remove substantial quantities of digoxin by either peritoneal or hemodialysis, have been unsuccessful due to their low clearance rate. The present study determined the in-vivo clearance rate for digoxin of a single microcapsule of 300 gm of activated charcoal. The clearance rate was 55 +/- 5 ml/min (mean +/- SEM) in the first hour and 48.4 +/- 4 ml/min in the second; these values are approximately five-fold higher than with other dialysis techniques. No evidence of a post-dialysis rebound increase in serum digoxin levels was found, implying that peripheral tissues can rapidly release digoxin to the diminishing serum pool. Preliminary data obtained suggest a beneficial effect on arrhythmias and lowering of the myocardial to serum rate of digoxin after hemoperfusion.

Topics: Animals; Charcoal; Digoxin; Dogs; Hemoperfusion; Myocardium; Tachycardia

Topics: Aged; Atrial Fibrillation; Digoxin; Humans; Tachycardia

Topics: Cesarean Section; Digoxin; Edema; Female; Fetal Diseases; Fetal Heart; Humans; Infant; Infant, Newborn; Male; Pregnancy; Sex Factors; Tachycardia

Topics: Asthma; Blood Circulation; Blood Transfusion; Brain Edema; Child, Preschool; Coma; Digoxin; Heart Massage; Humans; Male; Mannitol; Medication Errors; Respiration, Artificial; Seizures; Tachycardia; Theophylline

A case of atrioventricular reciprocal rhythm and chronic reciprocating tachycardia in a newborn infant is presented. Electrophysiological studies suggest that these rhythm disturbances are related to the presence of a right-sided atrioventricular accessory pathway capable only of retrograde conduction (concealed Wolff-Parkinson-White syndrome). The technique of recording the sequence of atrial activation during the tachycardia is described and its clinical importance emphasised.

Topics: Cardiac Catheterization; Digoxin; Electrophysiology; Heart Block; Heart Conduction System; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Propranolol; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Administration, Oral; Cardiac Pacing, Artificial; Child; Child, Preschool; Digoxin; Drug Therapy, Combination; Electrocardiography; Heart Atria; Humans; Infant; Injections, Intramuscular; Injections, Intravenous; Phenytoin; Propranolol; Reserpine; Tachycardia

Topics: Arrhythmia, Sinus; Bronchopneumonia; Digoxin; Electrocardiography; Humans; Infant; Male; Syndrome; Tachycardia

In 59 digitalized and 3 non digitalized patients the effect of digitalis during the 1st to 4th days after transmural myocardial infarction was controlled. Rhythm disturbances in acute myocardial infarction may arise secondary to a complicating cardiac failure and may be influenced by digitalis. In 9 of 17 cases (53 p.c.) with ventricular or supraventricular extrasystoles daily doses of 0,4 mg beta-Methyldigoxin or 0,4 mg Digoxin i.v. resulted in undisturbed sinus rhythm. In two cases supraventricular tachycardia and extrasystoles with rapid ventricular rate were abolished by 1,2 mg beta-Methyldigoxin within 12 hours, in three other cases an improvement was recorded. Dysrhythmias or other complications did not occur in previously non digitalized patients. When the antiarrhythmic effect of digitalis cannot be obtained cardiodepressive complications by treatment with typical antiarrhythmic agents are diminished. In patients on digitalis and in cardiogenic shock, digitalization should be performed carefully. Intoxication leads to a diminution of cardiac output and to cardiac dysrhythmias.

Topics: Acute Disease; Adult; Aged; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Digitalis Glycosides; Digoxin; Drug Interactions; Female; Heart Block; Humans; Male; Middle Aged; Myocardial Infarction; Premedication; Shock, Cardiogenic; Tachycardia

In 20 patients with acute myocardial infarction hemodynamic controls were performed after digitalisation and following i.v. injection of 0,4 mg of Prindolol. Circulatory changes were most pronounced 5-15 min after Prindolol injection and consisted of decrease in heart rate of 7%, mean arterial blood pressure of 6%, cardiac output of 10,5%, stroke volume index of 5,1% and left ventricular work of 18%. An increase of pulmonary wedge pressure of 17%, pulmonary pressure of 9%, mean right atrial pressure of 16% and peripheral arterial resistance of 6% were calculated. In 5 cases a favourable effect on extrasystoles and in 2 cases on sinus tachycardia were observed. Not infrequently, during the initial phase of acute myocardial infarction, a hyperadrenergic state may be noted. Prindolol may be indicated, when circulatory changes or arrhythmias are suspect to be the result of this hyperadrenergic stimulation. A simultaneous digitalisation may inhibit a more intensive cardiodepression.

Topics: Acute Disease; Adult; Aged; Blood Pressure; Cardiac Complexes, Premature; Cardiac Output; Digitalis Glycosides; Digoxin; Female; Heart Rate; Heart Ventricles; Hemodynamics; Humans; Injections, Intravenous; Male; Middle Aged; Myocardial Infarction; Pindolol; Pulmonary Artery; Shock, Cardiogenic; Tachycardia; Time Factors; Vascular Resistance

Serum digoxin levels, estimated by radioimmuno assay, technique, and the pattern of cardiac arrhythmias due to digoxin intoxication seem to be correlated in cases with high serum digoxin levels. The prognostic value of those correlations is demonstrated and discussed. Serial observations of the course of cardiac arrhythmias under the suspicion of digoxin intoxication together with blood level measurements allow to introduce more objective criteria in clinical management of poor risk patients receiving digoxin.

Topics: Arrhythmias, Cardiac; Bradycardia; Cardiac Complexes, Premature; Cardiac Glycosides; Digoxin; Heart Block; Humans; Tachycardia

Topics: Animals; Depression, Chemical; Digoxin; Dogs; Hypokalemia; Myocardial Contraction; Tachycardia

Topics: Aminophylline; Digitalis Glycosides; Digoxin; Diuretics; Heart Failure; Heart Rate; Humans; Hypokalemia; Hyponatremia; Intermittent Positive-Pressure Breathing; Mineralocorticoid Receptor Antagonists; Oxygen; Potassium Deficiency; Pulmonary Edema; Tachycardia; Thyroid Diseases

It was established by means of radioimmunoassay that the blood concentration of Digoxin in patients with congestive heart failure depends not only on the dose of the drug given, but also on the stage of cardiac insufficiency. With equal daily doses, higher Digoxin concentrations were observed in patients with more severe cardiac insufficiency. The analysis of the obtained data has demonstrated that in 75% of the patients with signs of digitalis intoxication the concentration of Digoxin in blood exceeded 2.5 ng/ml. In animal experiments it was established that a distinct reduction of the toxic threshold took place in rabbits with acute myocardial infarction, acute pulmonary embolism, congestive cardiac failure, this threshold being determined by the amount of intravenously injected Strophantin that causes persistent ventricular tachycardia.

Topics: Digoxin; Heart Failure; Humans; Strophanthins; Tachycardia

Thirty intact dogs were studied to determine digoxin concentration in various tissues after ventricular tachycardia had been induced by digoxin infusion. A control group was infused solely with digoxin. A second group was made acutely hypokalemic by glucose-insulin infusion before the digoxin infusion. A third group was infused with glucose and digoxin to determine the effect of increased blood glucose levels and osmalarity on the induction of ventricular tachycardia. Results were: (1) The amount of digoxin infused to produce ventricular tachycardia did not differ getween the normal and hypokalemic groups. (2) The concentration of digoxin in various parts of the heart, other muscle tissue, renal cortex, and liver did not differ between the normal and acutely hypokalemic dogs although the amount excreted in bile and urine was reduced in hypokalemia. (3) Acute hypokalemia did not sensitize the myocardium to the arrhythmogenic effects of digoxin. (4) Ventricular tachcardia occurred at a similar plasma digoxin level in normal and acutely hypokalemic dogs. (5) In dogs with a lowered plasma potassium level, junctional tachycardia occurred whereas it did not occur in normal dogs or those with only a high blood glucose level. (6) Ventricular tachycardia occurred in the hyperglycemic dogs at a plasma digoxin level of 170 ng/ml, which was significantly greater than in the other experiments (7) Acute hyperglycemia reduced the mean rate of myocaridal uptake of digoxin into atria and right and left ventricular tissue; and the concentration of digoxin in atria, left ventricle, and interventricular septum was lower at the time of ventricular tachycardia than occurred in normal dogs. (8) Lowering the plasma potassium level in the presence of acute hyperglycemia, which occurred with the glucose-insulin infusion, did increase the myocardial uptake of digoxin. Similar effects of hyperglycemia were noted on mean hepatic uptake and excretion of digoxin and also the renal uptake of the glycoside.

Topics: Animals; Body Temperature; Digoxin; Dogs; Electrocardiography; Hyperglycemia; Hypokalemia; Myocardium; Tachycardia

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

Clinical, electrocardiographic and laboratory data were found out in 52 patients with cardiac arrhythmias and conduction defects due to digoxin intoxication. Forty six nontoxic patients were also studied for comparison. Blood urea concentration was significantly higher in toxic patients as compared to nontoxic ones (P less than 0-01). Ventricular bigeminy and trigeminy (38.6%), multifocal ventricular premature beats (25%) and second or third degree A-V blocks (25%) were very much prevalent. Fairly good correlations have been observed between different cardiac arrhythmias and serum digoxin levels. Significantly higher mean serum digoxin levels were observed in patients with A-V block and multifocal ventricular premature beats as compared to patients with supraventricular arrhythmias.

Topics: Adult; Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Female; Heart Block; Heart Failure; Humans; Male; Middle Aged; Pulmonary Heart Disease; Rheumatic Heart Disease; Tachycardia; Ventricular Fibrillation

Topics: Administration, Oral; Digitalis Glycosides; Digoxin; Edrophonium; Humans; Lanatosides; Metaraminol; Neostigmine; Parasympathomimetics; Propranolol; Quinidine; Tachycardia; Verapamil

The effects of potassium canrenoate on arrhythmias induced by long-term progressive digoxin toxicity were studied in eight conscious beagle dogs. Sinus bradycardia and sinoatrial block, as well as atrioventricular (A-V) conduction disturbances, were consistently alleviated by administration of potassium canrenoate. Premature supraventricular (including junctional) and ventricular depolarizations as well as ventricular tachycardias were also suppressed. Although potassium canrenoate always terminated the digitalis-induced arrhythmias, it usually converted the rhythm to sinus arrhythmia rather than to normal sinus rhythm. Equimolar sodium canrenoate, but not potassium chloride, had similar reversal effects on arrhythmias induced by long-term digoxin intoxication. These data indicate that canrenoate, a diuretic agent with reported positive inotropic effects, may be useful in the treatment of digitalis-induced arrhythmias in man.

Topics: Animals; Arrhythmia, Sinus; Arrhythmias, Cardiac; Atrioventricular Node; Bradycardia; Bundle of His; Digoxin; Diuretics; Dogs; Electrocardiography; Female; Heart Block; Heart Ventricles; Ketosteroids; Male; Mineralocorticoid Receptor Antagonists; Potassium; Potassium Chloride; Pregnadienes; Sodium; Tachycardia

Of the 27 patients described, 23 were in cardiogenic shock, 2 had severe left ventricular failure, and 2 had medically refractory ventricular tachycardia. Utilizing intraaortic counterpulsation, adequate systemic blood pressure was initially restored in 19 patients. Nine of these were subsequently weaned from circulatory assistance, but only three were discharged from the hospital and are currently alive. The remaining 10 patients who derived initial benefit from circulatory assistance were balloon-dependent in that they could not be weaned from circulatory assistance. Eight of these patients subsequently underwent cardiac catheterization; four had inoperable disease. The remaining four patients underwent surgery for either resection of the area of infarction and/or for myocardial revascularization; only one survived to subsequently leave the hospital. Ventricular volumes were abnormal and ejection fractions were below 30 per cent in all the patients in cardiogenic shock except one who underwent cardiac catheterization and ultimately died. Ejection fractions were greater than 30 per cent in the two patients with cardiogenic shock who were weaned from balloon support and survived to leave the hospital without surgery. Both of these patients had inferior myocardial infarction. The data obtained from this experience suggest that intraaortic counterpulsation is a very useful adjunct to currently existing medical measures to treat both cardiogenic shock and medically refractory left ventricular failure but that most patients have such extensive disease that they can neither be weaned from balloon support nor undergo successful infarctectomy or myocardial revascularization.

Topics: Adult; Aged; Assisted Circulation; Blood Pressure; Cardiac Catheterization; Cardiac Volume; Digoxin; Diuretics; Female; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Plasma Substitutes; Shock, Cardiogenic; Tachycardia

Topics: Aged; Bradycardia; Digoxin; Electrocardiography; Female; Heart Conduction System; Humans; Propranolol; Tachycardia

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Digitalis Glycosides; Digoxin; Female; Humans; Male; Middle Aged; Tachycardia

Digoxin, in a common clinical dose and at a low serum level, brought out severe manifestations of sinus node dysfunction in a patient who had previously undergone successful mitral valve replacement. This report presents the results of extensive clinical and electrophysiologic studies of this patient before and after a digoxin challenge. In the absence of cardiac glycoside, the only demonstrable abnormalities of sinus node function were mild resting sinus bradycardia and failure to respond to atropine administration. Responses to isoproterenol administration, programmed premature atrial stimulation, and overdrive pacing at several cycle lengths were normal. Following the administration of intravenous digoxin, 1.025 mg/24 hrs, the resting sinus cycle length increased and the response to overdrive pacing became markedly abnormal. The latter was followed by sinus pauses in excess of six seconds, even at relatively slow overdrive pacing rates. The electrophysiologic and clinical implications of these data are discussed. It is suggested that despite previous reports that digitalis preparations are relatively well tolerated by patients with sick sinus syndrome, caution should be used when administering these drugs to this group of patients.

Topics: Arrhythmia, Sinus; Atrioventricular Node; Atropine; Bradycardia; Digoxin; Electrocardiography; Heart Conduction System; Heart Failure; Heart Rate; Humans; Isoproterenol; Male; Middle Aged; Sinoatrial Node; Syndrome; Tachycardia

Paroxysmal supraventricular tachycardia with left bundle branch block was found in a six-year-old girl. After prophylactic treatment with digitalis and with beta-adrenergic blocking agents, intermittent left bundle branch blocks appeared frequently. Thereby one could see repeatedly the pattern of a dependent Wenckebach phenomenon not yet described in childhood. Dependent Wenckebach phenomenon means the gradual development of a complete bundle branch block depending on the increasing atrial frequency drugin respiratory sinusarrhythmia. Immediately after complete bundle branch block, when the atrial frequency decreases significantly, the conductiondisturbance again normalized. Contrary to this, preexisting left bundle branch block disappeared when the frequency was increased by Orciprenalininfusions and be exercise. An evident explanation for this contrary behaviour cannot be given.

Topics: Arrhythmia, Sinus; Bundle-Branch Block; Child; Digoxin; Electrocardiography; Exercise Test; Heart; Heart Block; Heart Conduction System; Humans; Metaproterenol; Propranolol; Tachycardia

The introduction of the Gamma Coat 125I-Digoxin Radioimmunoassay has simplified the digoxin determination to an extent that it may be used even in general hospitals with an intensive care unit. The total time for a stat determination has been reduced to 70 min. The coefficient of variation of the digoxin determination at low levels (less than 0.8 ng/ml) was less than 15% for simultaneous and repeated measurements even when using one of the inexpensive nuclear counting systems. At high levels (greater than 2.5 ng/ml) the coefficient of variation showed to be less than 6%. Hemolysis, low albumine concentration and other than digoxin-bound isotopes in the blood samples did not cause methologic problems. Provided that resorption and elimination kinetics of the different digoxin preparations were taken into account, digoxin levels of more than 2 ng/ml as measured by the Gamma Coat method in patients with normal renal function plasma were usually associated with clinical signs of overdosage; therapeutic concentrations were mostly higher than 1.2 ng/ml. The incidence of digitalis toxicity with high digoxin levels was lower in uremic than in normal patients. According to preliminary observations in dialysis patients this increase in tolerance to digitalis, may be a consequence of hyperkalemia and renal acidosis. Erroneously high digoxin concentrations were found in patients up to 2 hrs after injection of high doses of spironolactone (400-1000 mg) due to cross reaction. Therapeutic concentrations of digitoxin (10-25 ng/ml) caused only subtherapeutic digoxin concentrations of 0.4-0.9 ng/ml.

Topics: Anuria; Binding Sites, Antibody; Digoxin; Drug Tolerance; False Positive Reactions; Humans; Iodine Radioisotopes; Potassium; Radioimmunoassay; Renal Dialysis; Spironolactone; Tachycardia; Time Factors; Tritium

Serum glycoside concentration was 2.3 ng/ml or more in 299 patients digitalised with digoxin or digoxin derivatives. Mean serum glycoside concentration was 3.4 +/- 1.3 ng/ml (range 2.3-11.00 ng per ml). Usually, high serum concentrations were associated with advanced den or digoxin-derivative overdosage occurred in only 10% of patients. Almost three quarters of those with intoxication had impaired renal function. There was some evidence that low body-weight increased the potential risk of intoxication.

Topics: Arrhythmias, Cardiac; Body Weight; Digoxin; Heart Block; Humans; Kidney Failure, Chronic; Tachycardia

According to own experiences and after a review of the literature a survey of therapy of cardiac arrhythmias in infancy and childhood is given. In this age group most of the occurring cardiac arrhythmias are harmless and pass without serious circulatory disturbances. Therefore in these cases no specific treatment is necessary, except of course the treatment and management of the disease which is causing the arrythmia. This report is concerned more detailed with the therapy of rhythm disturbances which are life threatening or will become fatal if they continue untreated for a longer period. In spite of the therapeutic recommendations given we are aware of the fact that it is impossible to predict the success of therapy. This turned out to be so especially in the case of tachycardias. The difficulties in long-term management of postoperative heart block are mentioned. Antiarrhythmic drugs, their indications, efficacy, side-effects and contraindications are listed in separate tables ("FdM-Tabellen für die Praxis" Nr. 30/1975, Fortschr. Med. 93, 30: 1447, 1975).

Topics: Age Factors; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Child; Child, Preschool; Digoxin; Electric Countershock; Heart Block; Humans; Infant; Metaproterenol; Pacemaker, Artificial; Tachycardia; Verapamil

Topics: Adult; Antihypertensive Agents; Benzofurans; Child; Child, Preschool; Diagnosis, Differential; Digoxin; Drug Synergism; Electrocardiography; Female; Heart Failure; Heart Rate; Humans; Infant; Infant, Newborn; Male; Prenylamine; Tachycardia; Time Factors

Topics: Adrenocorticotropic Hormone; Autopsy; Child; Dermatomyositis; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Heart Atria; Heart Failure; Heart Murmurs; Heart Neoplasms; Humans; Leg; Myxoma; Pain; Penicillins; Rest; Rheumatic Fever; Tachycardia; Ventricular Fibrillation

Topics: Adult; Digoxin; Female; Humans; Tachycardia

Topics: Aged; Creatinine; Digoxin; Female; Heart Block; Hospitalization; Humans; Male; Middle Aged; Nausea; Potassium; Radioimmunoassay; Tachycardia; Time Factors; Urea; Vomiting

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: Arrhythmia, Sinus; Arrhythmias, Cardiac; Coronary Disease; Digoxin; Diuretics; Electroconvulsive Therapy; Endocarditis, Bacterial; Heart Aneurysm; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Lidocaine; Myocardial Infarction; Pacemaker, Artificial; Pericarditis, Constrictive; Potassium Deficiency; Rupture; Spironolactone; Tachycardia; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Diagnosis, Differential; Digoxin; Electrocardiography; Heart Conduction System; Humans; Male; Pacemaker, Artificial; Tachycardia

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digitalis Glycosides; Digoxin; Drug Synergism; Drug Therapy, Combination; Electrocardiography; Heart Conduction System; Heart Rate; Humans; Lanatosides; Propranolol; Quinidine; Refractory Period, Electrophysiological; Tachycardia

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Digoxin; Diuretics; Electrocardiography; Exercise Test; Humans; Tachycardia

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

Topics: Adult; Arrhythmia, Sinus; Bradycardia; Digoxin; Electrocardiography; Female; Fetus; Humans; Pacemaker, Artificial; Pregnancy; Pregnancy Complications, Cardiovascular; Tachycardia

Topics: Acidosis; Atrial Fibrillation; Bundle-Branch Block; Calcium; Colon, Sigmoid; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Humans; Hyperkalemia; Hypocalcemia; Hypokalemia; Infant; Potassium; Tachycardia; Urinary Diversion; Water-Electrolyte Balance

Topics: Age Factors; Aged; Aortic Diseases; Arrhythmias, Cardiac; Cardanolides; Coronary Disease; Digoxin; Female; Gastrointestinal Diseases; Heart Block; Heart Failure; Heart Valve Diseases; Humans; Lung Diseases; Male; Middle Aged; Mitral Valve Insufficiency; Rheumatic Heart Disease; Tachycardia

Topics: Administration, Oral; Coronary Disease; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Injections, Intravenous; Kidney Failure, Chronic; Male; Myocardial Infarction; Phenytoin; Tachycardia

Topics: Adult; Aged; Atrial Fibrillation; Bundle-Branch Block; Cardiac Complexes, Premature; Digoxin; Electrocardiography; Female; Heart Block; Heart Conduction System; Heart Diseases; Heart Failure; Humans; Male; Tachycardia

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

Topics: Aged; Blood Pressure; Body Surface Area; Cardiac Output; Coronary Disease; Digoxin; Electrocardiography; Female; Heart Failure; Heart Rate; Heart Ventricles; Hemodynamics; Humans; Injections, Intravenous; Male; Middle Aged; Myocardial Infarction; Potassium; Pulmonary Artery; Tachycardia; Vascular Resistance

Topics: Animals; Arrhythmias, Cardiac; Blood Pressure; Cats; Digitoxin; Digoxin; Ethanolamines; Female; Heart; Heart Rate; Male; Nitrobenzenes; Oxygen; Partial Pressure; Phenethylamines; Tachycardia

Topics: Age Factors; Arrhythmia, Sinus; Cardiac Catheterization; Child; Digoxin; Diuretics; Electrocardiography; Heart Atria; Heart Failure; Heart Rate; Humans; Male; Propranolol; Syncope; Tachycardia

Topics: Administration, Oral; Age Factors; Child; Digoxin; Humans; Injections, Intravenous; Lidocaine; Male; Phenytoin; Procainamide; Propranolol; Quinidine; Tachycardia

Topics: Adolescent; Adult; Aged; Animals; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Bradycardia; Cardiac Catheterization; Digoxin; Dogs; Electrocardiography; Electrodes, Implanted; Female; Functional Laterality; Heart Atria; Heart Conduction System; Humans; Male; Middle Aged; Ouabain; Pacemaker, Artificial; Tachycardia; Vagotomy

Topics: Aged; Atrial Fibrillation; Digoxin; Electrocardiography; Heart Conduction System; Humans; Male; Tachycardia

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: Aged; Analgesia; Anti-Arrhythmia Agents; Blood Volume; Bradycardia; Cardiovascular Diseases; Diazepam; Digoxin; Diuretics; Dopamine; Glucagon; Heart Failure; Humans; Hypertension; Hypotension; Male; Myocardial Infarction; Norepinephrine; Phentolamine; Plasma Substitutes; Potassium; Tachycardia

Topics: Adult; Aged; Arrhythmias, Cardiac; Bradycardia; Coronary Care Units; Digoxin; Diuretics; Electrocardiography; Female; Heart Atria; Heart Block; Heart Failure; Heart Ventricles; Hospitals, Teaching; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Shock, Cardiogenic; Tachycardia; Ventricular Fibrillation

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

Topics: Adult; Angina Pectoris; Diabetes Mellitus; Digoxin; Electrocardiography; Female; Heart Conduction System; Heart Ventricles; Humans; Hypertension; Hypokalemia; Tachycardia

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Catecholamines; Diagnosis, Differential; Digoxin; Electric Countershock; Electrocardiography; Heart Conduction System; Humans; Lidocaine; Myocardial Infarction; Potassium; Procainamide; Quinidine; Tachycardia; Time Factors

Topics: Adolescent; Adult; Age Factors; Angiocardiography; Cardiac Catheterization; Child; Child, Preschool; Digoxin; Drug Synergism; Electric Countershock; Electrocardiography; Female; Heart Ventricles; Humans; Infant; Lidocaine; Male; Procainamide; Quinidine; Tachycardia; Time Factors; Ventricular Fibrillation

Topics: Adolescent; Adult; Aged; Anti-Arrhythmia Agents; Child; Child, Preschool; Digoxin; Edrophonium; Electrocardiography; Female; Heart Rate; Heart Ventricles; Humans; Male; Middle Aged; Quinidine; Tachycardia

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: Adult; Aged; Angina Pectoris; Arrhythmias, Cardiac; Blood Pressure; Cardiac Complexes, Premature; Coronary Disease; Digoxin; Geriatrics; Heart Diseases; Heart Failure; Humans; Hypertension; Middle Aged; Morpholines; Myocardial Infarction; Phenethylamines; Pulmonary Heart Disease; Pulse; Tachycardia

Topics: Animals; Biomechanical Phenomena; Cardanolides; Cardiac Complexes, Premature; Digitalis Glycosides; Digoxin; Dogs; Electric Stimulation; Heart; Heart Conduction System; Heart Rate; Heart Ventricles; Ouabain; Statistics as Topic; Tachycardia; Time Factors

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

Topics: Acetanilides; Adrenergic beta-Antagonists; Adult; Amino Alcohols; Atrial Flutter; Bronchitis; Bronchodilator Agents; Caffeine; Digoxin; Electrocardiography; Humans; Male; Middle Aged; Nicotine; Sympatholytics; Tachycardia; Vagus Nerve

Topics: Acetanilides; Adrenergic beta-Antagonists; Aged; Amino Alcohols; Angina Pectoris; Arrhythmia, Sinus; Bundle-Branch Block; Diagnosis, Differential; Digoxin; Electric Countershock; Electrocardiography; Female; Humans; Lidocaine; Male; Middle Aged; Myocardial Infarction; Myxedema; Tachycardia; Thyroxine

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: Age Factors; Atrial Flutter; Digoxin; Drug Resistance; Electric Countershock; Electrocardiography; Female; Heart Failure; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intramuscular; Injections, Intravenous; Male; Pregnancy; Prognosis; Radiography; Sex Factors; Tachycardia

Specific antibodies to digoxin were isolated from antisera of sheep immunized with a digoxin-human serum albumin conjugate. The antibody was purified by adsorption to an immunoadsorbent, synthesized by coupling a ouabain-ribonuclease conjugate to bromoacetyl-cellulose, followed by elution with 25 mM ouabain. Ouabain was dissociated from antibody by denaturation in 6 M guanidine. The renatured antibody bound 1.6 mol of digoxin per mol and had an association constant of 1.6 x 10(8) M(-1). At near-stoichiometric concentrations, either purified antibody to digoxin, or its papain-digested product (Fab-Fc), reversed digoxin-induced: (a) inhibition of (86)Rb transport in human erythrocytes, (b) increase in developed tension in isolated guinea-pig atrial strips, and (c) ventricular tachycardia in intact dogs, and also corrected digoxin-induced automaticity in isolated guineapig atrial strips.

Topics: Adsorption; Animals; Antibodies; Binding Sites; Biological Transport; Cellulose; Centrifugation; Chromatography, Gel; Digoxin; Erythrocytes; Guinea Pigs; Heart; Heart Atria; Humans; Immune Sera; Immunization; Immunochemistry; In Vitro Techniques; Ouabain; Papain; Protein Denaturation; Ribonucleases; Rubidium; Sheep; Tachycardia

Topics: Digoxin; Electrocardiography; Female; Humans; Hypokalemia; Middle Aged; Potassium; Tachycardia

Topics: Arrhythmias, Cardiac; Bradycardia; Digoxin; Electric Countershock; Electrocardiography; Humans; Isoproterenol; Lidocaine; Pacemaker, Artificial; Tachycardia

Topics: Adult; Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Cardiac Complexes, Premature; Diagnosis, Differential; Digoxin; Electrocardiography; Heart Block; Humans; Middle Aged; Poisoning; Tachycardia

Topics: Adult; Aged; Anti-Arrhythmia Agents; Atropine; Digitalis Glycosides; Digoxin; Electrocardiography; Female; Heart Ventricles; Humans; Isoproterenol; Lidocaine; Male; Middle Aged; Pacemaker, Artificial; Phenytoin; Procainamide; Propranolol; Quinidine; Tachycardia; Ventricular Fibrillation

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

Topics: Age Factors; Aged; Arrhythmias, Cardiac; Digoxin; Electrocardiography; Female; Humans; Tachycardia

Digitalis glycosides remain the cornerstone of treatment in cardiac failure. The increasing frequency of toxic effects is a cause for concern. Review of 80 elderly patients receiving digoxin on a maintenance basis, some of whom had toxic effects, shows that in almost three-quarters of the group digoxin was stopped without detriment. Elderly patients on maintenance treatment should be reviewed, and in the absence of a known primary cardiac lesion an attempt should be made to withdraw digoxin.

Topics: Aged; Bronchitis; Digoxin; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Tachycardia

Topics: Aged; Arrhythmias, Cardiac; Bradycardia; Coronary Disease; Digoxin; Electrocardiography; Heart Block; Humans; Hypertension; Ischemic Attack, Transient; Middle Aged; Rheumatic Heart Disease; Syncope; Tachycardia

A radioimmunoassay for serum digoxin concentration has been used to study the interrelationships of circulating levels of the drug and various factors in the clinical setting in 48 hospitalized patients with cardiac rhythm disturbances due to digoxin intoxication. 131 patients on maintenance doses of digoxin without toxicity and 48 patients with equivocal evidence of digoxin excess were also studied and compared with the toxic group. Patients with cardiac rhythm disturbances due to digoxin intoxication tended to be older and to have diminished renal function compared with the nontoxic group; body weight, serum potassium concentration, underlying cardiac rhythm, and nature of cardiac disease were not significantly different for the groups as a whole. Despite comparable mean daily digoxin dosages, digoxin intoxicated patients had a mean serum digoxin concentration of 3.7 +/-1.0 (SD) ng/ml, while nontoxic patients had a mean level of 1.4 +/-0.7 ng/ml (P < 0.001), 90% of patients without evidence of toxicity had serum digoxin concentrations of 2.0 ng/ml or less, while 87% of the toxic group had levels above 2.0; the range of overlap between the two groups extended from 1.6 to 3.0 ng/ml. Patients with atrioventricular block as their principal toxic manifestation had a significantly lower mean serum digoxin concentration than those in whom ectopic impulse formation was the chief rhythm disturbance. Patients with equivocal evidence of digoxin excess had received comparable daily maintenance doses of digoxin but had a mean serum concentration of 1.9 +/-0.8 ng/ml, intermediate between those of the nontoxic (P < 0.005) and toxic (P < 0.001) groups. Renal function as judged by mean blood urea nitrogen concentration was also intermediate. The data indicate that knowledge of the serum digoxin concentration, weighed in the clinical context, is useful in the management of patients receiving this drug.

Topics: Age Factors; Arrhythmias, Cardiac; Body Weight; Computers; Digoxin; Heart Failure; Humans; Kidney; Potassium; Radioimmunoassay; Tachycardia; Tritium

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

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: Aged; Arrhythmias, Cardiac; Digoxin; Humans; Hydrochlorothiazide; Male; Tachycardia

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: Aged; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Humans; Metaraminol; Tachycardia; Wolff-Parkinson-White Syndrome

Topics: Age Factors; Aged; Aminophylline; Arrhythmias, Cardiac; Body Weight; Digoxin; Epidemiologic Methods; Female; Furosemide; Heparin; Humans; Male; Massachusetts; Meperidine; Middle Aged; Morphine; Prochlorperazine; Statistics as Topic; Tachycardia

Topics: Arrhythmia, Sinus; Child; Child, Preschool; Digoxin; Electrocardiography; Electroconvulsive Therapy; Female; Heart Failure; Hemiplegia; Humans; Infant; Male; Methysergide; Neostigmine; Phenylephrine; Procainamide; Propranolol; Quinidine; Reserpine; Tachycardia

Topics: Animals; Arrhythmias, Cardiac; Cats; Digoxin; Drug Synergism; Electric Countershock; Electrocardiography; Humans; Tachycardia; Ventricular Fibrillation

Topics: Animals; Antibodies; Antibody Formation; Antidotes; Digoxin; Dogs; Heart Block; Poisoning; Rabbits; Tachycardia

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atropine; Bradycardia; Cardiac Complexes, Premature; Digoxin; Drug Hypersensitivity; Dyspnea; Heart Rate; Humans; Male; Middle Aged; Propranolol; Tachycardia; Uremia

Topics: Aged; Bradycardia; Digoxin; Humans; Male; Pacemaker, Artificial; Propranolol; Tachycardia

Topics: Atrial Fibrillation; Cardiac Catheterization; Chronic Disease; Digoxin; Electric Countershock; Heart Atria; Humans; Male; Methods; Middle Aged; Tachycardia

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

Topics: Adolescent; Adult; Digoxin; Female; Humans; Male; Tachycardia

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: Adult; Digoxin; Electric Countershock; Electrocardiography; Ethanolamines; Furosemide; Heart Ventricles; Humans; Male; Potassium Chloride; Procainamide; Quinidine; Tachycardia

Topics: Animals; Cardiac Output; Digoxin; Dogs; Edetic Acid; Heart Rate; Heart Ventricles; Hemodynamics; Male; Tachycardia

Topics: Adult; Aged; Digoxin; Electrocardiography; Female; Heart Failure; Humans; Male; Tachycardia

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: Animals; Arrhythmias, Cardiac; Digoxin; Dogs; Electric Countershock; Electric Stimulation; Electrocardiography; Electrophysiology; Heart Block; Heart Conduction System; Quinidine; Tachycardia; Ventricular Fibrillation

Topics: Aminophylline; Digoxin; Diuretics; Drug Therapy; Electric Countershock; Electrocardiography; Heart Failure; Humans; Hypotension; Metaraminol; Myocardial Infarction; Organomercury Compounds; Phenylephrine; Quinidine; Tachycardia; Ventricular Fibrillation

Topics: Anticoagulants; Atrial Flutter; Digoxin; Drug Therapy; Electric Countershock; Heart Block; Heart Failure; Humans; Quinidine; Tachycardia

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

Topics: Animals; Digoxin; Dogs; Edetic Acid; Electrocardiography; Tachycardia

Topics: Bradycardia; Delirium; Digitalis; Digitalis Glycosides; Digitoxin; Digoxin; Gynecomastia; Humans; Lanatosides; Male; Neuritis; Paresthesia; Tachycardia; Thrombocytopenia; Toxicology; Trigeminal Neuralgia; Urticaria

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digoxin; Electric Countershock; Electric Stimulation Therapy; Electrocardiography; Humans; Phenindione; Quinidine; Tachycardia

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Digitalis Glycosides; Digoxin; Drug Therapy; Electric Countershock; Electric Stimulation Therapy; Potassium; Procaine; Quinidine; Tachycardia; Toxicology

Topics: Adams-Stokes Syndrome; Cervix Uteri; Diagnosis, Differential; Digoxin; Electrocardiography; Female; Heart Block; Humans; Menstruation Disturbances; Phenobarbital; Succinylcholine; Surgical Procedures, Operative; Tachycardia; Tachycardia, Ventricular

Topics: Anti-Arrhythmia Agents; Atropine; Blood Pressure; Blood Pressure Determination; Digoxin; Dogs; Epinephrine; Hydrocarbons; Methoxamine; Ouabain; Pharmacology; Quinidine; Research; Tachycardia; Tachycardia, Ventricular

Topics: Atrial Fibrillation; Diagnosis, Differential; Digoxin; Electrocardiography; Humans; Procainamide; Prognosis; Quinidine; Tachycardia; Tachycardia, Ventricular; Wolff-Parkinson-White Syndrome