Santa Casa de Misericórdia
Belo Horizonte, Brazil
Correspondence to: Henrique Horta Veloso, MD, Rua Professor Estevão Pinto 846/304, Belo Horizonte, MG, Brazil, 30220–060; e-mail: email@example.com
To the Editor:
The experimental investigation of Friedman et al (October
2000)1 demonstrated that acetylstrophanthidin (AS) exerts
a favorable effect on atrial fibrillation (AF)-induced atrial stunning,
action that was not related to its effects on the duration of AF. In
this study, the effect of cardiac glycosides on the duration of AF
deserves further analysis.
Following atrial stimulation, the authors observed that “although the
baseline duration … of AF in control dogs was the same as that
found in … dogs before the administration of the glycoside
(102 ± 70 s vs 106 ± 72 s), AF duration in the control dogs at a
time comparable to that at which the glycoside had been administered
was sharply lower (106 ± 72 s vs 7 ± 3 s; p = 0.12 …
). Thus, the lack of a difference in AF duration following AS might
actually indicate an enhancement of the arrhythmia by the
Friedman et al1 further stated that “randomized
controlled studies … have demonstrated little benefit of these
drugs for alleviation AF. When compared to controls, neither IV nor
oral cardiac glycosides have been found to increase the number of
cardioversions or to shorten the time it takes for the cessation of
AF,” and also “the administration of IV or oral cardiac glycosides
does not appear to be effective in converting or shortening episodes of
AF,” findings that were considered “consistent with the effects of
AS on experimental AF observed in this study.”1
Digoxin had been considered to have no efficacy for conversion of AF to
sinus rhythm.2–3 However, trials have shown the advantage
of digoxin over placebo for conversion to sinus rhythm in patients with
shorter AF duration ( < 72 h).4–6 As the AF induced in
the study had a very short duration,1 their experimental
model probably was very susceptible to the action of digoxin in the
conversion of AF. Furthermore, the reported reduction in AF duration,
in comparison with the dogs that received AS, did not reach statistical
I do believe that the favorable effect of cardiac glycosides on
AF-induced atrial stunning might be important in clinical practice and
should be established in clinical investigations. However, the role of
the cardiac glycosides in the duration of AF deserves further
investigation to clarify the differences between clinical and
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