Hornestam B, Held P, Edvardsson N
Dept. of Internal Medicine and Cardiology of Sahlgrenska University Hospital, Göteborg, Sweden.
Clin Cardiol. 1999 Feb;22(2):96-102. doi: 10.1002/clc.4960220208.
Studies of healthy volunteers or patients in sinus rhythm have indicated that treatment with digoxin produces characteristic changes in the electrocardiogram (ECG). No randomized, placebo-controlled studies are available and no study has investigated the effect on ECG in patients with atrial fibrillation.
In a substudy to a trial comparing the therapeutic effect of intravenously administered digoxin with placebo in patients with acute atrial fibrillation, we investigated these effects as well as the relation between ECG changes and serum concentration of digoxin.
In all, 167 patients were included. Standard ECGs recorded at baseline, and at 2, 6, 12, and 16 h after randomization were digitized, and changes in RR-intervals, QRS width, ST-segment amplitude at 60 ms after the J point, T-wave amplitude, and QTc interval were calculated. Furthermore, the correlation between the serum concentration of digoxin at 16 h after inclusion and changes on the ECG was analyzed.
Compared with placebo, digoxin resulted in an increase in RR-interval (p < 0.0001), a decrease in ST-segment and T-wave amplitude (p = 0.009 and p = 0.002, respectively), and in the QTc interval (p = 0.01). These changes were present 2 h after the first dose, but were more pronounced after 16 h. There was no significant correlation between serum concentration of digoxin and ECG changes at 16 h.
Compared with placebo, digoxin produces significant changes on ECG in patients with acute atrial fibrillation. The changes are in accordance with previous findings in individuals in sinus rhythm. There was no correlation between serum concentration of digoxin and ECG changes.
对健康志愿者或窦性心律患者的研究表明，地高辛治疗会使心电图（ECG）产生特征性变化。目前尚无随机、安慰剂对照研究，也没有研究调查地高辛对房颤患者心电图的影响。
在一项比较静脉注射地高辛与安慰剂对急性房颤患者治疗效果的试验的子研究中，我们调查了这些影响以及心电图变化与地高辛血清浓度之间的关系。
总共纳入了167例患者。将基线时以及随机分组后2、6、12和16小时记录的标准心电图数字化，并计算RR间期、QRS波宽度、J点后60毫秒处ST段幅度、T波幅度和QTc间期的变化。此外，分析了纳入后16小时地高辛血清浓度与心电图变化之间的相关性。
与安慰剂相比，地高辛导致RR间期增加（p < 0.0001），ST段和T波幅度降低（分别为p = 0.009和p = 0.002），以及QTc间期增加（p = 0.01）。这些变化在首次给药后2小时出现，但在16小时后更为明显。在16小时时，地高辛血清浓度与心电图变化之间无显著相关性。
与安慰剂相比，地高辛使急性房颤患者的心电图产生显著变化。这些变化与先前对窦性心律个体的研究结果一致。地高辛血清浓度与心电图变化之间无相关性。
