First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.
Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt an der Saale, Germany.
Scand Cardiovasc J. 2022 Dec;56(1):198-207. doi: 10.1080/14017431.2022.2091793.
. The study sought to assess the prognostic value of treatment with digitalis on long-term prognosis in patients with ventricular tachyarrhythmias and atrial fibrillation (AF) and/or heart failure (HF). . Data regarding the outcome of digitalis therapy following ventricular tachyarrhythmias is limited. A large retrospective registry was used including consecutive patients with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with digitalis were compared to patients without. The primary prognostic endpoint was all-cause mortality at 3 years, secondary endpoints comprised a composite arrhythmic endpoint (i.e. recurrences of ventricular tachyarrhythmias, appropriate implantable cardioverter defibrillator (ICD) therapies, sudden cardiac death) and cardiac rehospitalization. Kaplan Mayer survival curves, multivariable cox regression, and time trend analyses were applied for statistics. Eight hundred and thirty-one patients were included (20% treated with digitalis and 80% without). At 3 years, digitalis treatment was not associated with all-cause mortality following ventricular tachyarrhythmias (24 21%, log-rank = .736; HR = 1.063; 95% CI 0.746-1.515; = .736). However, digitalis therapy was associated with an increased risk of the composite arrhythmic endpoint (38 23%; log-rank = .001; HR = 1.719; 95% CI 1.279-2.311; = .001) and cardiac rehospitalization (31 18%; log-rank = .001; HR = 1.829; 95% CI 1.318-2.538; = .001), which was still evident within multivariable Cox regression analyses. Finally, digitoxin may be associated with a worse prognosis than digoxin. Digitalis therapy was not associated with mortality in patients with ventricular tachyarrhythmias, but with increased risk of the composite arrhythmic endpoint and cardiac rehospitalization at 3 years.
研究旨在评估在伴有室性心动过速心律失常和心房颤动（AF）和/或心力衰竭（HF）的患者中，使用洋地黄类药物治疗的预后价值对长期预后的影响。关于室性心动过速心律失常后洋地黄类药物治疗结局的数据有限。一项大型回顾性登记研究纳入了 2002 年至 2015 年期间发生室性心动过速（VT）或颤动（VF）的连续患者。比较了接受洋地黄类药物治疗的患者和未接受治疗的患者。主要预后终点为 3 年全因死亡率，次要终点包括复合心律失常终点（即室性心动过速心律失常复发、适当的植入式心脏复律除颤器（ICD）治疗、心源性猝死）和心脏再入院。应用 Kaplan-Meier 生存曲线、多变量 Cox 回归和时间趋势分析进行统计学分析。纳入了 831 名患者（20%接受洋地黄类药物治疗，80%未接受治疗）。在 3 年时，室性心动过速心律失常后洋地黄类药物治疗与全因死亡率无关（24% 21%，对数秩检验= 0.736；HR = 1.063；95%CI 0.746-1.515；= 0.736）。然而，洋地黄类药物治疗与复合心律失常终点（38% 23%；对数秩检验= 0.001；HR = 1.719；95%CI 1.279-2.311；= 0.001）和心脏再入院（31% 18%；对数秩检验= 0.001；HR = 1.829；95%CI 1.318-2.538；= 0.001）的风险增加相关，多变量 Cox 回归分析仍显示这种相关性。最后，地高辛可能比洋地黄毒苷预后更差。在伴有室性心动过速心律失常的患者中，洋地黄类药物治疗与死亡率无关，但与 3 年时复合心律失常终点和心脏再入院的风险增加相关。
