Gerrit Frommeyer1, Johannes Brachmann2, Hüseyin Ince3,4, Stefan G Spitzer5, Dierk Thomas6, Stephan Willems7, Burghard Schumacher8,9, Petra Schirdewahn10, Thorsten Lewalter11, Matthias Hochadel12, Jochen Senges12, Lars Eckardt13. 1. Clinic for Cardiology II - Electrophysiology, University of Münster, Münster, Germany. gerrit.frommeyer@ukmuenster.de. 2. Department of Cardiology, Klinikum Coburg, Coburg, Germany. 3. Klinik für Allgemeine Innere Medizin-Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban und im Friedrichshain, Berlin, Germany. 4. Abteilung für Kardiologie, Universitätsmedizin Rostock, Rostock, Germany. 5. Praxisklinik Herz und Gefäße Dresden, Dresden, Germany. 6. Department of Cardiology, University Hospital, Heidelberg, Germany. 7. Department of Electrophysiology, Heart Center University Hospital Hamburg-Eppendorf, Hamburg, Germany. 8. Herz- und Gefäßklinik, Bad Neustadt/Saale, Germany. 9. Westpfalz-Klinikum, Kaiserslautern, Germany. 10. Kardiologische Gemeinschaftspraxis Saalkreis, Salzatal, Germany. 11. Department of Cardiology, Internistisches Klinikum München Süd, Munich, Germany. 12. Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany. 13. Clinic for Cardiology II - Electrophysiology, University of Münster, Münster, Germany.
Abstract
BACKGROUND: Digitalis glycosides are employed for rate control of atrial fibrillation. Recent studies suggested potential harmful effects of digitalis monotherapy and combination with antiarrhythmic drugs. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcome in patients undergoing catheter ablation of supraventricular arrhythmias. METHODS AND RESULTS: The German Ablation Registry is a nationwide, prospective registry with a 1-year follow-up investigating 12,566 patients receiving catheter ablations of supraventricular arrhythmias in 52 German centres. The present analysis focussed on pharmacotherapy in 8608 patients undergoing catheter ablation of atrial tachycardia, atrial fibrillation, or atrial flutter. Patients receiving digitalis therapy (n = 417) were older and presented a significantly increased prevalence of comorbidities including coronary artery disease, heart failure, diabetes, and pulmonary disease. One-year mortality was significantly higher in digitalis-treated patients (4.7% vs. 1.3%, p < 0.001), most strikingly in patients undergoing ablation of atrial flutter. This effect was maintained after adjustment for important risk factors. Similar results were obtained for as the combined endpoint of death, myocardial infarction, stroke and major bleeding (6.6% vs. 2.7%, p < 0.001), and non-fatal rehospitalisations (54.1% vs. 45.1%, p = 0.001). CONCLUSION: In the present study of patients undergoing catheter ablation of supraventricular arrhythmias, an association of digitalis therapy with increased mortality and an increased rate of other severe adverse events were observed. The results from this 'real-life' registry are consistent with previously published studies. However, whether digitalis therapy promotes a poorer prognosis or may just serve as a marker for this aspect cannot be thoroughly interpreted.
BACKGROUND:Digitalis glycosides are employed for rate control of atrial fibrillation. Recent studies suggested potential harmful effects of digitalis monotherapy and combination with antiarrhythmic drugs. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcome in patients undergoing catheter ablation of supraventricular arrhythmias. METHODS AND RESULTS: The German Ablation Registry is a nationwide, prospective registry with a 1-year follow-up investigating 12,566 patients receiving catheter ablations of supraventricular arrhythmias in 52 German centres. The present analysis focussed on pharmacotherapy in 8608 patients undergoing catheter ablation of atrial tachycardia, atrial fibrillation, or atrial flutter. Patients receiving digitalis therapy (n = 417) were older and presented a significantly increased prevalence of comorbidities including coronary artery disease, heart failure, diabetes, and pulmonary disease. One-year mortality was significantly higher in digitalis-treated patients (4.7% vs. 1.3%, p < 0.001), most strikingly in patients undergoing ablation of atrial flutter. This effect was maintained after adjustment for important risk factors. Similar results were obtained for as the combined endpoint of death, myocardial infarction, stroke and major bleeding (6.6% vs. 2.7%, p < 0.001), and non-fatal rehospitalisations (54.1% vs. 45.1%, p = 0.001). CONCLUSION: In the present study of patients undergoing catheter ablation of supraventricular arrhythmias, an association of digitalis therapy with increased mortality and an increased rate of other severe adverse events were observed. The results from this 'real-life' registry are consistent with previously published studies. However, whether digitalis therapy promotes a poorer prognosis or may just serve as a marker for this aspect cannot be thoroughly interpreted.
Authors: Ann-Kathrin Rahm; Patrick Lugenbiel; Marco Ochs; Benjamin Meder; Dierk Thomas; Hugo A Katus; Eberhard Scholz Journal: Clin Res Cardiol Date: 2020-03-06 Impact factor: 5.460