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Communications to the Editor |

Effects of Cardiac Glycosides on Atrial Fibrillation FREE TO VIEW

Henrique Horta Veloso, MD
Author and Funding Information

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: hhorta@cardiol.br



Chest. 2001;120(5):1753-1754. doi:10.1378/chest.120.5.1753
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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 glycoside.”1

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.23 However, trials have shown the advantage of digoxin over placebo for conversion to sinus rhythm in patients with shorter AF duration ( < 72 h).46 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 significance.

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 experimental studies.

References

Friedman, HS, Win, M, Hussain, A, et al (2000) Effects of cardiac glycosides on atrial contractile dysfunction after short-term atrial fibrillation.Chest118,1116-1126. [PubMed] [CrossRef]
 
Falk, RH, Knowlton, AA, Bernard, AS, et al Digoxin for converting atrial fibrillation to sinus rhythm: a randomized, double-blinded trial.Ann Intern Med1987;106,503-506. [PubMed]
 
Jordaens, L, Trouerbach, J, Calle, P, et al Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo.Eur Heart J1997;18,643-648. [PubMed]
 
Stühlinger, HG, Domanovits, H, Gamper, G, et al The DIGAF study (digoxin in atrial fibrillation): cardioversion of atrial fibrillation with high dose digoxin [abstract].Circulation1997;96,I-454
 
for the PAFIT-3 Investigators. Bianconi, L, Mennuni, M Comparison between propafenone and digoxin administered intravenously to patients with acute atrial fibrillation.Am J Cardiol1998;82,584-588. [PubMed]
 
Veloso, HH, de Paola, AAV Digoxin versus placebo for conversion of acute atrial fibrillation to sinus rhythm.Am J Cardiol1999;83,1300-1301
 

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References

Friedman, HS, Win, M, Hussain, A, et al (2000) Effects of cardiac glycosides on atrial contractile dysfunction after short-term atrial fibrillation.Chest118,1116-1126. [PubMed] [CrossRef]
 
Falk, RH, Knowlton, AA, Bernard, AS, et al Digoxin for converting atrial fibrillation to sinus rhythm: a randomized, double-blinded trial.Ann Intern Med1987;106,503-506. [PubMed]
 
Jordaens, L, Trouerbach, J, Calle, P, et al Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo.Eur Heart J1997;18,643-648. [PubMed]
 
Stühlinger, HG, Domanovits, H, Gamper, G, et al The DIGAF study (digoxin in atrial fibrillation): cardioversion of atrial fibrillation with high dose digoxin [abstract].Circulation1997;96,I-454
 
for the PAFIT-3 Investigators. Bianconi, L, Mennuni, M Comparison between propafenone and digoxin administered intravenously to patients with acute atrial fibrillation.Am J Cardiol1998;82,584-588. [PubMed]
 
Veloso, HH, de Paola, AAV Digoxin versus placebo for conversion of acute atrial fibrillation to sinus rhythm.Am J Cardiol1999;83,1300-1301
 
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