Effect of digoxin on shocks in cardiac resynchronization therapy-defibrillator patients with coronary artery disease.
Identifieur interne : 003316 ( Main/Merge ); précédent : 003315; suivant : 003317Effect of digoxin on shocks in cardiac resynchronization therapy-defibrillator patients with coronary artery disease.
Auteurs : Evan Adelstein [États-Unis] ; David Schwartzman [États-Unis] ; Sandeep Jain [États-Unis] ; Raveen Bazaz [États-Unis] ; Samir Saba [États-Unis]Source :
- The American journal of cardiology [ 1879-1913 ] ; 2014.
Descripteurs français
- KwdFr :
- Cardiotoniques (administration et posologie), Digoxine (administration et posologie), Débit systolique (), Défibrillateurs implantables, Femelle, Fonction ventriculaire gauche, Humains, Maladie des artères coronaires (), Maladie des artères coronaires (physiopathologie), Mort subite cardiaque (), Mort subite cardiaque (étiologie), Mâle, Prévention primaire (), Relation dose-effet des médicaments, Résultat thérapeutique, Sujet âgé, Thérapie de resynchronisation cardiaque (), Troubles du rythme cardiaque (), Troubles du rythme cardiaque (physiopathologie), Études de suivi, Études prospectives.
- MESH :
- administration et posologie : Cardiotoniques, Digoxine.
- physiopathologie : Maladie des artères coronaires, Troubles du rythme cardiaque.
- étiologie : Mort subite cardiaque.
- Débit systolique, Défibrillateurs implantables, Femelle, Fonction ventriculaire gauche, Humains, Maladie des artères coronaires, Mort subite cardiaque, Mâle, Prévention primaire, Relation dose-effet des médicaments, Résultat thérapeutique, Sujet âgé, Thérapie de resynchronisation cardiaque, Troubles du rythme cardiaque, Études de suivi, Études prospectives.
English descriptors
- KwdEn :
- Aged, Arrhythmias, Cardiac (complications), Arrhythmias, Cardiac (physiopathology), Arrhythmias, Cardiac (prevention & control), Cardiac Resynchronization Therapy (methods), Cardiotonic Agents (administration & dosage), Coronary Artery Disease (complications), Coronary Artery Disease (physiopathology), Coronary Artery Disease (therapy), Death, Sudden, Cardiac (etiology), Death, Sudden, Cardiac (prevention & control), Defibrillators, Implantable, Digoxin (administration & dosage), Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Male, Primary Prevention (methods), Prospective Studies, Stroke Volume (drug effects), Treatment Outcome, Ventricular Function, Left.
- MESH :
- chemical , administration & dosage : Cardiotonic Agents, Digoxin.
- complications : Arrhythmias, Cardiac, Coronary Artery Disease.
- drug effects : Stroke Volume.
- etiology : Death, Sudden, Cardiac.
- methods : Cardiac Resynchronization Therapy, Primary Prevention.
- physiopathology : Arrhythmias, Cardiac, Coronary Artery Disease.
- prevention & control : Arrhythmias, Cardiac, Death, Sudden, Cardiac.
- therapy : Coronary Artery Disease.
- Aged, Defibrillators, Implantable, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Treatment Outcome, Ventricular Function, Left.
Abstract
Digoxin provides symptomatic relief in patients with systolic heart failure, yet it has potential proarrhythmic mechanisms and has not been formally studied in patients with cardiac resynchronization therapy-defibrillators (CRT-Ds). We evaluated the association between digoxin use and appropriate tachyarrhythmia therapy in patients with CRT-D with advanced heart failure, analyzing the incidence of appropriate device therapies and overall survival in 350 consecutive primary prevention recipients with CRT-D with baseline left ventricular ejection fraction (LVEF) ≤35%, non-right bundle-branch block native QRS complex ≥120 ms, New York Heart Association III to IV heart failure, and significant coronary artery disease. Digoxin was prescribed in 162 patients (46%) at discharge from CRT-D implant. Over 48 ± 32 months of follow-up, 59 patients (17%) received ≥1 appropriate shock. Digoxin therapy was associated with shorter time to first shock in intention-to-treat (corrected hazard ratio 2.18, 95% confidence interval 1.23 to 3.87, p = 0.007) and on-treatment analysis (corrected hazard ratio 2.27, 95% confidence interval 1.27 to 4.07, p = 0.006). Patients prescribed digoxin had a lower baseline LVEF, and digoxin therapy was associated with increased risk of shocks only in patients with LVEF <22% (median); there was no increased risk in patients with LVEF ≥22%. Overall survival and incidence of antitachycardia pacing were similar regardless of digoxin therapy. In conclusion, digoxin therapy is associated with increased likelihood of appropriate CRT-D shocks for rapid ventricular arrhythmias in primary prevention patients with coronary artery disease, and this risk appears to be most evident in patients with more severe baseline LV dysfunction. Digoxin use should be reexamined prospectively in patients with CRT-D.
DOI: 10.1016/j.amjcard.2013.12.007
PubMed: 24440327
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pubmed:24440327Le document en format XML
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Electronic address: adelsteinec@upmc.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Schwartzman, David" sort="Schwartzman, David" uniqKey="Schwartzman D" first="David" last="Schwartzman">David Schwartzman</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Jain, Sandeep" sort="Jain, Sandeep" uniqKey="Jain S" first="Sandeep" last="Jain">Sandeep Jain</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Bazaz, Raveen" sort="Bazaz, Raveen" uniqKey="Bazaz R" first="Raveen" last="Bazaz">Raveen Bazaz</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Saba, Samir" sort="Saba, Samir" uniqKey="Saba S" first="Samir" last="Saba">Samir Saba</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2014">2014</date><idno type="RBID">pubmed:24440327</idno><idno type="pmid">24440327</idno><idno type="doi">10.1016/j.amjcard.2013.12.007</idno><idno type="wicri:Area/PubMed/Corpus">003911</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">003911</idno><idno type="wicri:Area/PubMed/Curation">003885</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">003885</idno><idno type="wicri:Area/PubMed/Checkpoint">003885</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">003885</idno><idno type="wicri:Area/Ncbi/Merge">000C90</idno><idno type="wicri:Area/Ncbi/Curation">000C90</idno><idno type="wicri:Area/Ncbi/Checkpoint">000C90</idno><idno type="wicri:Area/Main/Merge">003316</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effect of digoxin on shocks in cardiac resynchronization therapy-defibrillator patients with coronary artery disease.</title><author><name sortKey="Adelstein, Evan" sort="Adelstein, Evan" uniqKey="Adelstein E" first="Evan" last="Adelstein">Evan Adelstein</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: adelsteinec@upmc.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Schwartzman, David" sort="Schwartzman, David" uniqKey="Schwartzman D" first="David" last="Schwartzman">David Schwartzman</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Jain, Sandeep" sort="Jain, Sandeep" uniqKey="Jain S" first="Sandeep" last="Jain">Sandeep Jain</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Bazaz, Raveen" sort="Bazaz, Raveen" uniqKey="Bazaz R" first="Raveen" last="Bazaz">Raveen Bazaz</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Saba, Samir" sort="Saba, Samir" uniqKey="Saba S" first="Samir" last="Saba">Samir Saba</name><affiliation wicri:level="2"><nlm:affiliation>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh, Pennsylvania.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Heart and Vascular Institute at the University of Pittsburgh, Pittsburgh</wicri:cityArea></affiliation></author></analytic><series><title level="j">The American journal of cardiology</title><idno type="eISSN">1879-1913</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Arrhythmias, Cardiac (complications)</term><term>Arrhythmias, Cardiac (physiopathology)</term><term>Arrhythmias, Cardiac (prevention & control)</term><term>Cardiac Resynchronization Therapy (methods)</term><term>Cardiotonic Agents (administration & dosage)</term><term>Coronary Artery Disease (complications)</term><term>Coronary Artery Disease (physiopathology)</term><term>Coronary Artery Disease (therapy)</term><term>Death, Sudden, Cardiac (etiology)</term><term>Death, Sudden, Cardiac (prevention & control)</term><term>Defibrillators, Implantable</term><term>Digoxin (administration & dosage)</term><term>Dose-Response Relationship, Drug</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Primary Prevention (methods)</term><term>Prospective Studies</term><term>Stroke Volume (drug effects)</term><term>Treatment Outcome</term><term>Ventricular Function, Left</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Cardiotoniques (administration et posologie)</term><term>Digoxine (administration et posologie)</term><term>Débit systolique ()</term><term>Défibrillateurs implantables</term><term>Femelle</term><term>Fonction ventriculaire gauche</term><term>Humains</term><term>Maladie des artères coronaires ()</term><term>Maladie des artères coronaires (physiopathologie)</term><term>Mort subite cardiaque ()</term><term>Mort subite cardiaque (étiologie)</term><term>Mâle</term><term>Prévention primaire ()</term><term>Relation dose-effet des médicaments</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Thérapie de resynchronisation cardiaque ()</term><term>Troubles du rythme cardiaque ()</term><term>Troubles du rythme cardiaque (physiopathologie)</term><term>Études de suivi</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Cardiotonic Agents</term><term>Digoxin</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Cardiotoniques</term><term>Digoxine</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Arrhythmias, Cardiac</term><term>Coronary Artery Disease</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Stroke Volume</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Death, Sudden, Cardiac</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Cardiac Resynchronization Therapy</term><term>Primary Prevention</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Maladie des artères coronaires</term><term>Troubles du rythme cardiaque</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Arrhythmias, Cardiac</term><term>Coronary Artery Disease</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Arrhythmias, Cardiac</term><term>Death, Sudden, Cardiac</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Coronary Artery Disease</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Mort subite cardiaque</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Defibrillators, Implantable</term><term>Dose-Response Relationship, Drug</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Prospective Studies</term><term>Treatment Outcome</term><term>Ventricular Function, Left</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Débit systolique</term><term>Défibrillateurs implantables</term><term>Femelle</term><term>Fonction ventriculaire gauche</term><term>Humains</term><term>Maladie des artères coronaires</term><term>Mort subite cardiaque</term><term>Mâle</term><term>Prévention primaire</term><term>Relation dose-effet des médicaments</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Thérapie de resynchronisation cardiaque</term><term>Troubles du rythme cardiaque</term><term>Études de suivi</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Digoxin provides symptomatic relief in patients with systolic heart failure, yet it has potential proarrhythmic mechanisms and has not been formally studied in patients with cardiac resynchronization therapy-defibrillators (CRT-Ds). We evaluated the association between digoxin use and appropriate tachyarrhythmia therapy in patients with CRT-D with advanced heart failure, analyzing the incidence of appropriate device therapies and overall survival in 350 consecutive primary prevention recipients with CRT-D with baseline left ventricular ejection fraction (LVEF) ≤35%, non-right bundle-branch block native QRS complex ≥120 ms, New York Heart Association III to IV heart failure, and significant coronary artery disease. Digoxin was prescribed in 162 patients (46%) at discharge from CRT-D implant. Over 48 ± 32 months of follow-up, 59 patients (17%) received ≥1 appropriate shock. Digoxin therapy was associated with shorter time to first shock in intention-to-treat (corrected hazard ratio 2.18, 95% confidence interval 1.23 to 3.87, p = 0.007) and on-treatment analysis (corrected hazard ratio 2.27, 95% confidence interval 1.27 to 4.07, p = 0.006). Patients prescribed digoxin had a lower baseline LVEF, and digoxin therapy was associated with increased risk of shocks only in patients with LVEF <22% (median); there was no increased risk in patients with LVEF ≥22%. Overall survival and incidence of antitachycardia pacing were similar regardless of digoxin therapy. In conclusion, digoxin therapy is associated with increased likelihood of appropriate CRT-D shocks for rapid ventricular arrhythmias in primary prevention patients with coronary artery disease, and this risk appears to be most evident in patients with more severe baseline LV dysfunction. Digoxin use should be reexamined prospectively in patients with CRT-D.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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