Cardiology
General Cardiology
Safety of Transvenous Temporary Cardiac Pacing in Patients with Accidental Digoxin Overdose and Symptomatic BradycardiaChen J.-Y.a · Liu P.-Y.a,b · Chen J.-H.a · Lin L.-J.aaDivision of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital and bInstitute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
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Article / Publication Details
Received: December 01, 2003
Accepted: February 12, 2004
Published online: September 29, 2004
Issue release date: September 2004
Number of Print Pages: 4
Number of Figures: 0
Number of Tables: 2
ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)
For additional information: https://www.karger.com/CRD
Abstract
Background: Patients with digoxin intoxication may need transvenous temporary cardiac pacing (TCP) when symptomatic bradyarrhythmias are present. However, it has been reported that TCP might be associated with fatal arrhythmias in patients with acute digitalis intoxication caused by attempted suicide. The aim of this study was to assess the safety of TCP in patients with accidental digoxin-related symptomatic bradyarrhythmias. Materials and Methods: Seventy patients (30 men; age 74 ± 12 years) were enrolled in this retrospective study. Patients were divided into two groups: group 1 with TCP and group 2 without TCP. A digoxin overdose was defined as a serum digoxin level higher than 2.0 ng/ml combined with the presence of digoxin-related symptoms. Detailed clinical characteristics were reviewed on the basis of the medical records. Results: Group 1 included 24 patients (34.3%, 10 men). The rhythms prior to pacemaker insertion in group 1 included sinus arrest with junctional bradyarrhythmias (n = 9), atrial fibrillation with a slow ventricular rate (n = 11), and high-degree atrioventricular block (n = 4). The mean duration of pacemaker implantation was 5.8 ± 2.9 days (2–12 days). There was no major arrhythmic event or mortality after TCP in group 1. Two patients in group 2 (4%) died of ventricular tachyarrhythmias. Group 1 had a higher level of blood urea nitrogen (45.1 ± 26.0 vs. 33.4 ± 19.3 mg/dl), of left ventricular ejection fraction (68 vs. 56%), and of digoxin (4.4 ± 2.1 vs. 3.4 ± 1.3 ng/ml) but a lower serum calcium level (8.7 ± 0.6 vs. 9.1 ± 0.8 mg/dl). Conclusion: TCP was safe for patients with a digoxin overdose complicated by symptomatic bradycardia and should be recommended in such situations. However, this conclusion does not apply to acute digoxin intoxication as a result of attempted suicide.
© 2004 S. Karger AG, Basel
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References
- Bismuth C, Motte G, Conso F, Chauvin M, Gaultier M: Acute digitoxin intoxication treated by intracardiac pacemaker. Experience in sixty-eight patients. Clin Toxicol 1977;10:443–456.
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Taboulet P, Baud FJ, Bismuth C, Vicaut E: Acute digitalis intoxication – Is pacing still appropriate? Clin Toxicol 1993;31:261–273.
External Resources
- Rosen MR: Cellular electrophysiology of digitalis toxicity. J Am Coll Cardiol 1985;5:22A–34A.
Article / Publication Details
Received: December 01, 2003
Accepted: February 12, 2004
Published online: September 29, 2004
Issue release date: September 2004
Number of Print Pages: 4
Number of Figures: 0
Number of Tables: 2
ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)
For additional information: https://www.karger.com/CRD
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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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