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- Catecholaminergic polymorphic ventricular tachycardia and other polymorphic ventricular tachycardias with a normal QT interval
- Control of ventricular rate in atrial fibrillation: Pharmacologic therapy
- Control of ventricular rate in atrial flutter
- Electrophysiology of arrhythmias due to digitalis poisoning
- Second degree atrioventricular block: Mobitz type I (Wenckebach block)
- Sinoatrial nodal pause; arrest; and exit block
- Third degree (complete) atrioventricular block
- Use of digoxin in heart failure due to systolic dysfunction
Basic approach to arrhythmias due to digitalis toxicity
| AuthorAry L Goldberger, MD | Section EditorsMorton F Arnsdorf, MD, MACCStephen J Traub, MD | Deputy EditorGordon M Saperia, MD, FACC |
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- INTRODUCTION
- INCIDENCE OF DIGITALIS TOXICITY
- Plasma digoxin levels
- TYPES OF CARDIAC TOXICITY
- INCREASED ECTOPY
- Ventricular arrhythmias
- Bidirectional ventricular tachycardia
- AV junctional rhythms
- ENHANCED VAGAL ACTIVITY
- Sinus bradycardia and sinoatrial block
- AV block and AV dissociation
- Atrial fibrillation or flutter with a slow ventricular rate
- INCREASED ECTOPY PLUS ENHANCED VAGAL ACTIVITY
- REFERENCES
GRAPHICS
Cardiac glycosides (usually digoxin) are used clinically in two situations: heart failure due to systolic dysfunction; and in certain supraventricular tachyarrhythmias [1]:
- The ability to enhance cardiac contractility and modulate neurohumoral activation can lead to symptomatic improvement in systolic heart failure, although it is unclear if survival is prolonged. (See "Use of digoxin in heart failure due to systolic dysfunction".)
- Digitalis also slows conduction through the atrioventricular (AV) junction (node) by increasing vagal tone. It may also have a sympathoinhibitory effect in therapeutic doses. As a result, it is sometimes used (usually adjunctively with beta blockers or calcium channel blockers) for controlling the ventricular response in atrial fibrillation and atrial flutter when there is excessively rapid transmission of stimuli from the atria to the ventricles through the AV junction. (See "Control of ventricular rate in atrial fibrillation: Pharmacologic therapy" and "Control of ventricular rate in atrial flutter".)
- Digitalis may also be effective in the treatment of certain types of reentrant paroxysmal supraventricular tachycardia involving the AV node.
The incidence and basic clinical features of digitalis excess and toxicity are presented here. The electrophysiology and management of digitalis intoxication are discussed separately. (See "Electrophysiology of arrhythmias due to digitalis poisoning".)
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| References |
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- Gheorghiade, M, Adams, KF Jr, Colucci, WS. Digoxin in the management of cardiovascular disorders. Circulation 2004; 109:2959.
- Hussain, Z, Swindle, J, Hauptman, PJ. Digoxin use and digoxin toxicity in the post-DIG trial era. J Card Fail 2006; 12:343.
- Mahdyoon, H, Battilana, G, Rosman, H, et al. The evolving pattern of digoxin intoxication: Observations at a large urban hospital from 1980 to 1988. Am Heart J 1990; 120:1189.
- Kelly, RA, Smith, TW. Recognition and management of digitalis toxicity. Am J Cardiol 1992; 69:108G.
- Adams, KF, Patterson, JH, Gattis, WA, et al. Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation trial: a retrospective analysis. J Am Coll Cardiol 2005; 46:497.
- Priori, SG, Napolitano, C, Memmi, M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002; 106:69.
- Bigger, JT Jr. Digitalis toxicity. J Clin Pharmacol 1985; 25:514.
- Kastor, JA, Yurchak, PM. Recognition of digitalis intoxication in the presence of atrial fibrillation. Ann Intern Med 1967; 67:1045.
