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Schupp T, Behnes M, Weiss C, Nienaber C, Reiser L, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, Rusnak J, Weidner K, Akin M, Mashayekhi K, Borggrefe M, Akin I. Digitalis Therapy and Risk of Recurrent Ventricular Tachyarrhythmias and ICD Therapies in Atrial Fibrillation and Heart Failure. Cardiology 2019; 142:129-140. [PMID: 31189160 DOI: 10.1159/000497271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study sought to assess the impact of treatment with digitalis on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients with atrial fibrillation (AF) and heart failure (HF). BACKGROUND The data regarding outcomes of digitalis therapy in ICD recipients are limited. METHODS A large retrospective registry was used, including consecutive ICD recipients with episodes of ventricular tachyarrhythmia between 2002 and 2016. Patients treated with digitalis were compared to patients without digitalis treatment. The primary prognostic outcome was first recurrence of ventricular tachyarrhythmia at 5 years. Kaplan-Meier and multivariable Cox regression analyses were applied. RESULTS A total of 394 ICD recipients with AF and/or HF was included (26% with digitalis treatment and 74% without). Digitalis treatment was associated with decreased freedom from recurrent ventricular tachy-arrhythmias (HR = 1.423; 95% CI 1.047-1.934; p = 0.023). Accordingly, digitalis treatment was associated with decreased freedom from appropriate ICD therapies (HR = 1.622; 95% CI 1.166-2.256; p = 0.004) and, moreover, higher rates of rehospitalization (38 vs. 21%; p = 0.001) and all-cause mortality (33 vs. 20%; p = 0.011). CONCLUSION Among ICD recipients suffering from AF and HF, treatment with digitalis was associated with increased rates of recurrent ventricular tachyarrhythmias and ICD therapies. However, the endpoints may also have been driven by interactions between digitalis, AF, and HF.
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Affiliation(s)
- Tobias Schupp
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany,
| | - Christel Weiss
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Linda Reiser
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
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Okin PM, Bang CN, Wachtell K, Hille DA, Kjeldsen SE, Dahlöf B, Devereux RB. Relationship of Sudden Cardiac Death to New-Onset Atrial Fibrillation in Hypertensive Patients With Left Ventricular Hypertrophy. Circ Arrhythm Electrophysiol 2013; 6:243-51. [PMID: 23403268 DOI: 10.1161/circep.112.977777] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter M. Okin
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Casper N. Bang
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Kristian Wachtell
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Darcy A. Hille
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Sverre E. Kjeldsen
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Björn Dahlöf
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Richard B. Devereux
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
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