+1 Recommend
1 collections
      • Record: found
      • Abstract: found
      • Article: found

      Safety of Transvenous Temporary Cardiac Pacing in Patients with Accidental Digoxin Overdose and Symptomatic Bradycardia

      a , a,b , a , a


      S. Karger AG

      Digoxin overdose, Bradyarrhythmias, Pacemaker

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.


          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.

          Related collections

          Most cited references 1

          • Record: found
          • Abstract: found
          • Article: not found

          Cellular electrophysiology of digitalis toxicity.

           Michael Rosen (1985)
          The toxic effects of digitalis are attributable in part to poisoning of the enzyme Na+-K+ ATPase and in part to the interactions of digitalis with the sympathetic and parasympathetic nervous systems. Additional modifiers of the toxic effects of digitalis include the concentrations of ions such as K+ and Ca2+, the age of the subject and the extent and type of cardiac disease. At the cellular electrophysiologic level, digitalis toxicity is seen as a depolarization of the membrane with the occurrence--individually or simultaneously--of abnormalities of impulse initiation (including delayed afterdepolarizations and abnormal automaticity) and abnormalities of conduction. The afterdepolarizations result in triggered arrhythmias that differ partially in their characteristics of onset and termination from automatic and reentrant arrhythmias. The cellular electrophysiologic basis for these arrhythmias induced by toxic concentrations of digitalis and their implications with respect to arrhythmogenesis in the in situ heart are explored in detail.

            Author and article information

            S. Karger AG
            September 2004
            29 September 2004
            : 102
            : 3
            : 152-155
            aDivision of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital and bInstitute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
            80483 Cardiology 2004;102:152–155
            © 2004 S. Karger AG, Basel

            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. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Tables: 2, References: 3, Pages: 4
            General Cardiology


            Comment on this article