Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA.
Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA.
JACC Clin Electrophysiol. 2024 Jul;10(7 Pt 1):1468-1476. doi: 10.1016/j.jacep.2024.03.042. Epub 2024 Jun 12.
Some studies have shown digoxin use to be associated with adverse outcomes, including increased mortality. There are limited data on whether digoxin use is associated with increased risk of ventricular tachycardia/ventricular fibrillation (VT/VF) in heart failure patients with an implantable cardioverter-defibrillator (ICD).
This study sought to assess whether digoxin use is associated with increased risk of VT/VF in patients with heart failure with reduced ejection fraction with a primary prevention ICD in landmark clinical trials.
The study cohort consisted of patients with an ICD or cardiac resynchronization therapy-defibrillator who were enrolled in 4 landmark MADIT trials (Multicenter Automatic Defibrillator Implantation Trials). We employed propensity score quintile stratification for treatment with digoxin as well as additional multivariable adjustment to assess the risk of digoxin vs no-digoxin therapy for the endpoints of first and recurrent VT/VF and all-cause mortality. The proportional hazards regression models for arrhythmia-specific endpoints incorporated adjustments for the competing risk of death.
At baseline, 1,155 of 4,499 patients were on digoxin (26%). After propensity score quintile stratification, patients prescribed digoxin were shown to exhibit a statistically significant 48% increased risk of VT/VF (P < 0.001), 42% increased risk of the composite of VT/VF or death (P < 0.001), and a 37% increased risk of all-cause mortality (P = 0.006). Digoxin use was also associated with increased risk of appropriate ICD shocks (HR: 1.91; P < 0.001) and with increased burden of VT/VF events (HR: 1.46; P = 0.001).
Our findings suggests that digoxin use is associated with ventricular tachyarrhythmia and death in heart failure with reduced ejection fraction patients with an ICD.
一些研究表明地高辛的使用与不良结局相关，包括死亡率增加。关于地高辛的使用是否与心力衰竭伴植入式心脏复律除颤器（ICD）患者的室性心动过速/心室颤动（VT/VF）风险增加相关，数据有限。
本研究旨在评估在具有射血分数降低的心力衰竭患者的标志性临床试验中，地高辛的使用是否与 ICD 一级预防患者的 VT/VF 风险增加相关。
研究队列包括在 4 项标志性 MADIT 试验（多中心自动除颤器植入试验）中入组的 ICD 或心脏再同步治疗除颤器患者。我们采用地高辛治疗的倾向评分五分位分层以及额外的多变量调整，以评估地高辛与无地高辛治疗的风险比，用于首次和复发性 VT/VF 以及全因死亡率的终点。心律失常特异性终点的比例风险回归模型纳入了死亡竞争风险的调整。
在基线时，4499 名患者中有 1155 名（26%）正在服用地高辛。在进行倾向评分五分位分层后，服用地高辛的患者表现出 VT/VF 的风险显著增加 48%（P<0.001），VT/VF 或死亡的复合终点风险增加 42%（P<0.001），全因死亡率风险增加 37%（P=0.006）。地高辛的使用也与适当 ICD 电击的风险增加相关（HR：1.91；P<0.001），以及 VT/VF 事件的负担增加相关（HR：1.46；P=0.001）。
我们的研究结果表明，地高辛的使用与心力衰竭伴射血分数降低的 ICD 患者的室性心动过速和死亡相关。
