Johnston G D, McDevitt D G
Lancet. 1979 Mar 17;1(8116):567-70. doi: 10.1016/s0140-6736(79)91002-x.
Discontinuation of digoxin in 56 patients with sinus rhythm who had been taking it for a long time did not produce clinical deterioration in 33 of 34 patients whose pre-withdrawal steady-state plasma-digoxin concentration was less than 0.8 ng/ml; fast atrial fibrillation developed in the other patient. 22 patients had plasma-digoxin levels between 0.8 and 2.0 ng/ml before withdrawal--of these, 7 deteriorated without digoxin (5 had atrial fibrillation, which was associated with congestive heart-failure, measurement of the pre-injection period/left-ventricular ejection time (P.E.P./L.V.E.T.) ratio suggested that digoxin did exert a sustained positive inotropic effect. Thus, successful discontinuation of digoxin was possible in 86% of the total group and was more likely when the plasma-digoxin concentration was below 0.8 ng/ml. Unexpected atrial fibrillation was the commonest development inthe 8 patients in whom digoxin withdrawal was unsuccessful.
56例长期服用地高辛的窦性心律患者停药后，34例撤药前稳态血浆地高辛浓度低于0.8 ng/ml的患者中，33例未出现临床病情恶化；另1例患者发生快速心房颤动。22例患者撤药前血浆地高辛水平在0.8至2.0 ng/ml之间，其中7例在停用洋地黄后病情恶化（5例发生心房颤动，伴有充血性心力衰竭，注射前期/左心室射血时间（P.E.P./L.V.E.T.）比值测量表明地高辛确实发挥了持续的正性肌力作用。因此，在整个组中86%的患者成功停用了地高辛，当血浆地高辛浓度低于0.8 ng/ml时更有可能成功停药。在8例停用洋地黄未成功的患者中，意外发生的心房颤动是最常见的情况。
