Hnatkova K, Murgatroyd F D, Poloniecki J, Waktare J E, Alferness C A, Camm A J, Malik M
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England.
Pacing Clin Electrophysiol. 1998 Sep;21(9):1735-40. doi: 10.1111/j.1540-8159.1998.tb00272.x.
The effects of digoxin on ventricular response during atrial fibrillation (AF) and consequent effects on arrhythmic symptoms have still not been fully explained. This study investigated whether the treatment by digoxin contributes to mid- and long-term stabilization of ventricular cycles in patients with paroxysmal AF. A population of 45 patients with paroxysmal AF underwent 24-hour ECG recordings during each arm of a randomized crossover trial comparing digoxin and placebo. This yielded 30 Holter recordings from 22 patients that contained AF episodes lasting in excess of 2 minutes and with acceptably low Holter noise. Each AF episode was divided into nonoverlapping segments of 30 seconds and the distribution of RR intervals in each segment was compared with the distribution of all other AF segments in the same recording using the Kolmogorov-Smirnov test. The percentage of tests that revealed significant differences at levels of P < or = 0.01, and P < or = 0.001 were sorted according to the time between the segments compared. The comparisons of these results were performed between: (a) all recordings on placebo (n = 16) and all recordings on digoxin (n = 14), and (b) between recordings on placebo and on digoxin in 8 patients in whom paired analysis was possible. Adjacent AF segments (distance 0) differed significantly only in < 30% of both recordings on placebo and on digoxin. However, with increasing the distance between segments, the proportion of the significant differences between RR interval distributions increased more with placebo than with digoxin (P < 10(-300), Chi-square test). Paired data revealed larger differences between placebo and digoxin with increasing distance between segments. Thus in patients with paroxysmal AF, digoxin leads to more reproducible patterns of ventricular cycles that may be better tolerated clinically.
地高辛对心房颤动（AF）时心室反应的影响以及对心律失常症状的后续影响尚未完全阐明。本研究调查了地高辛治疗是否有助于阵发性AF患者心室周期的中长期稳定。45例阵发性AF患者在一项比较地高辛和安慰剂的随机交叉试验的每个阶段均接受了24小时心电图记录。这产生了来自22例患者的30份动态心电图记录，其中包含持续超过2分钟且动态心电图噪声可接受地低的AF发作。每个AF发作被分为30秒的非重叠段，并使用Kolmogorov-Smirnov检验将每个段中RR间期的分布与同一记录中所有其他AF段的分布进行比较。根据比较的段之间的时间，对在P≤0.01和P≤0.001水平显示出显著差异的测试百分比进行排序。这些结果的比较在以下两者之间进行：（a）所有安慰剂记录（n = 16）和所有地高辛记录（n = 14），以及（b）在8例可行配对分析的患者中安慰剂记录和地高辛记录之间。相邻AF段（距离为0）在安慰剂记录和地高辛记录中均仅在<30%的情况下存在显著差异。然而，随着段之间距离的增加，RR间期分布之间显著差异的比例在安慰剂组中比在地高辛组中增加得更多（P<10⁻³⁰⁰，卡方检验）。配对数据显示，随着段之间距离的增加，安慰剂和地高辛之间的差异更大。因此，在阵发性AF患者中，地高辛可导致更可重复的心室周期模式，临床上可能耐受性更好。
