Clinic for Cardiology II - Electrophysiology, University of Münster, Münster, Germany.
Department of Cardiology, Klinikum Coburg, Coburg, Germany.
Clin Res Cardiol. 2019 Oct;108(10):1083-1092. doi: 10.1007/s00392-019-01442-w. Epub 2019 Feb 23.
Digitalis glycosides are employed for rate control of atrial fibrillation. Recent studies suggested potential harmful effects of digitalis monotherapy and combination with antiarrhythmic drugs. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcome in patients undergoing catheter ablation of supraventricular arrhythmias.
The German Ablation Registry is a nationwide, prospective registry with a 1-year follow-up investigating 12,566 patients receiving catheter ablations of supraventricular arrhythmias in 52 German centres. The present analysis focussed on pharmacotherapy in 8608 patients undergoing catheter ablation of atrial tachycardia, atrial fibrillation, or atrial flutter. Patients receiving digitalis therapy (n = 417) were older and presented a significantly increased prevalence of comorbidities including coronary artery disease, heart failure, diabetes, and pulmonary disease. One-year mortality was significantly higher in digitalis-treated patients (4.7% vs. 1.3%, p < 0.001), most strikingly in patients undergoing ablation of atrial flutter. This effect was maintained after adjustment for important risk factors. Similar results were obtained for as the combined endpoint of death, myocardial infarction, stroke and major bleeding (6.6% vs. 2.7%, p < 0.001), and non-fatal rehospitalisations (54.1% vs. 45.1%, p = 0.001).
In the present study of patients undergoing catheter ablation of supraventricular arrhythmias, an association of digitalis therapy with increased mortality and an increased rate of other severe adverse events were observed. The results from this 'real-life' registry are consistent with previously published studies. However, whether digitalis therapy promotes a poorer prognosis or may just serve as a marker for this aspect cannot be thoroughly interpreted.
地高辛类药物被用于控制心房颤动的心率。最近的研究表明地高辛单药治疗以及与抗心律失常药物联合使用可能存在潜在的有害作用。本研究旨在评估地高辛治疗在接受导管消融治疗室上性心律失常患者中的预后中的患病率和潜在影响。
德国消融登记处是一项全国性的前瞻性登记研究，对 52 个德国中心的 12566 例接受导管消融治疗室上性心律失常的患者进行了为期 1 年的随访。本分析集中在接受导管消融治疗房性心动过速、心房颤动或心房扑动的 8608 例患者中的药物治疗。接受地高辛治疗的患者（n=417）年龄较大，合并症的患病率显著增加，包括冠心病、心力衰竭、糖尿病和肺部疾病。地高辛治疗组的 1 年死亡率明显更高（4.7%比 1.3%，p<0.001），在接受心房扑动消融的患者中更为显著。在调整重要危险因素后，这种影响仍然存在。对于死亡、心肌梗死、卒中和大出血的联合终点（6.6%比 2.7%，p<0.001）和非致命性再入院（54.1%比 45.1%，p=0.001）也得到了类似的结果。
在本项接受导管消融治疗室上性心律失常的患者研究中，观察到地高辛治疗与死亡率增加以及其他严重不良事件发生率增加相关。来自该“真实世界”登记处的结果与之前发表的研究一致。然而，地高辛治疗是否会导致预后更差，或者只是作为预后的一个标志物，目前尚无法全面解释。
