Frommeyer Gerrit, Lange Philipp S, Kleemann Thomas, Stellbrink Christoph, Ince Hüseyin, Brachmann Johannes, Lewalter Thorsten, Hochadel Matthias, Senges Jochen, Eckardt Lars
Clinic for Cardiology II - Electrophysiology, University of Münster, Münster, Germany.
Department of Cardiology, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
Ann Noninvasive Electrocardiol. 2025 May;30(3):e70080. doi: 10.1111/anec.70080.
Digitalis glycosides are employed for rate control of atrial fibrillation and treatment of heart failure. Previous studies suggested potential harmful effects of digitalis therapy. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcomes in patients with systolic failure who were implanted with an ICD- or CRT-ICD system.
The German Device Registry is a nationwide, prospective registry with a 1-year follow-up investigating 4384 patients receiving either ICD or CRT systems in 52 German centers. The present analysis focused on the presence of digitalis therapy in 3826 patients undergoing device implantation. Patients receiving digitalis therapy (n = 800) presented a more severely impaired left ventricular function, higher NYHA class, and an increased incidence of left bundle branch block. Consequently, the implantation of CRT systems was more common in this group. One-year mortality did not significantly differ between both groups (9.1% vs. 7.4%, p = 0.14). Similar results were obtained for the combined endpoint, including death, myocardial infarction, and stroke. ICD shock delivery (19.7% vs. 15.0%, p = 0.006) and device revision (11.4% vs. 7.5%, p < 0.004) were more common in digitalis-treated patients.
In this study in patients undergoing ICD or CRT implantation, an association of digitalis therapy with an increased risk of device revision was observed. Of note, mortality or severe cardiovascular events did not differ between both groups. Furthermore, an increased risk of ICD shock delivery was observed in digitalis-treated patients.
洋地黄苷用于控制房颤心率及治疗心力衰竭。既往研究提示洋地黄治疗存在潜在有害影响。本研究旨在评估洋地黄治疗在植入植入式心律转复除颤器（ICD）或心脏再同步化治疗除颤器（CRT-ICD）系统的收缩性心力衰竭患者中的患病率及其对预后的潜在影响。
德国器械注册研究是一项全国性的前瞻性注册研究，对德国52个中心的4384例接受ICD或CRT系统治疗的患者进行了为期1年的随访。本分析聚焦于3826例接受器械植入患者中洋地黄治疗的情况。接受洋地黄治疗的患者（n = 800）左心室功能损害更严重，纽约心脏协会（NYHA）心功能分级更高，左束支传导阻滞发生率更高。因此，CRT系统在该组中植入更为常见。两组的1年死亡率无显著差异（9.1%对7.4%，p = 0.14）。包括死亡、心肌梗死和中风在内的复合终点也得到了类似结果。洋地黄治疗组患者的ICD电击治疗（19.7%对15.0%，p = 0.006）和器械翻修（11.4%对7.5%，p < 0.004）更为常见。
在本项针对接受ICD或CRT植入的患者的研究中，观察到洋地黄治疗与器械翻修风险增加有关。值得注意的是，两组间死亡率或严重心血管事件并无差异。此外，洋地黄治疗组患者的ICD电击治疗风险增加。
