Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y

Digitalis Therapy in Patients with Ventricular Tachyarrhythmias

T. Schupp1, J. Müller2, M. Abumayyaleh1, K. J. Weidner1, J. Rusnak1, K. A. Mashayekhi3, T. Bertsch4, I. Akin1, M. Behnes1

1I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; 2Herz- und Gefäß-Klinik Campus Bad Neustadt, Bad Neustadt a. d. Saale; 3Innere Medizin und Kardiologie, MediClin Herzzentrum Lahr/Baden, Lahr/Schwarzwald; 4Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg Nord, Nürnberg;

Objective: The study sought to assess the prognostic value of treatment with digitalis on long-term prognosis in patients with ventricular tachyarrhythmias and atrial fibrillation (AF) and/or heart failure (HF). Background: Data regarding outcome of digitalis therapy following ventricular tachyarrhythmias is limited. Methods: A large retrospective registry was used including consecutive patients with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with digitalis were compared to patients without. The primary prognostic endpoint was all-cause mortality at three years, secondary endpoints comprised a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, appropriate implantable cardioverter defibrillator (ICD) therapies, sudden cardiac death) and cardiac rehospitalization. Kaplan Mayer survival curves, multivariable cox regression and time trend analyses were applied for statistics.   Results: 831 patients were included (20% treated with digitalis and 80% without). At three years, digitalis treatment was not associated with all-cause mortality following ventricular tachyarrhythmias (24% vs. 21%, log rank p=0.736; HR=1.063; 95% CI 0.746-1.515; p=0.736)). However, digitalis therapy was associated with an increased risk of the composite arrhythmic endpoint (38% vs. 23%; log rank p=0.001; HR=1.719; 95% CI 1.279-2.311; p=0.001) and cardiac rehospitalization (31% vs. 18%; log rank p=0.001; HR=1.829; 95% CI 1.318-2.538; p=0.001), which was still evident within multivariable Cox regression analyses. Finally, digitoxin may be associated with worse prognosis than digoxin. Conclusion: Digitalis therapy was not associated mortality in patients with ventricular tachyarrhythmias, but with increased risk of the composite arrhythmic endpoint and cardiac rehospitalization at three years.

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