Digoxin atrial flutter

Dlgltoxin. Digitoxin is a cardiac glycoside obtained from Digitalis purpurea. Digitoxin is indicated in the treatment of atrial flutter, atrial fibrillation, and supraventricular tachycardia. Its electrophysiologic and adverse effects are similar to those described for digoxin (87). 

As with other Class I agents, patients treated with flecainide for atrial flutter have been reported with 1 1 atrioventricular conduction due to slowing the atrial rate. A paradoxical increase in the ventricular rate also may occur in patients with atrial fibrillation who receive flecainide. Concomitant negative chronotropic therapy such as digoxin or beta-blockers may lower the risk of this complication. 

Digitalis (DIGOXIN) 0.25-0.5 mg IV for paroxysmal supraventricular tachycardia (PSVT), atrial flutter and atrial fibrillation... 

Digoxin Atrial fibrillation and flutter with rapid ventricular response Adenosineldiopathic and re-entrant paroxysmal supraventricular tachycardia WPW, Wolf-Parkinson-White. 

Supraventricular tachycardia is the major arrhythmia indication for verapamil. Adenosine or verapamil are preferred over older treatments (propranolol, digoxin, edrophonium, vasoconstrictor agents, and cardioversion) for termination. Verapamil can also reduce the ventricular rate in atrial fibrillation and flutter. It only rarely converts atrial flutter and fibrillation to sinus rhythm. Verapamil is occasionally useful in ventricular arrhythmias. However, intravenous verapamil in a patient with sustained ventricular tachycardia can cause hemodynamic collapse. 

In 14 healthy men dofetilide 250 pg bd for 5 days had no effect on the pharmacokinetics of digoxin at a steady-state trough concentration of 1.0 ng/ml (258). However, in a placebo-controUed study in patients with atrial fibrillation or atrial flutter, conversion to sinus rhythm in patients given dofetilide was more likely if they were also given digoxin (259), so there may be a pharmacodynamic interaction. 

Talley JD, Wathen MS, Hurst JW. Hyperthyroid-induced atrial flutter-fibrillation with profound sinoatrial nodal pauses due to small doses of digoxin, verapamil, and propranolol. Clin Cardiol 1989 12(l) 45-7. 

Another important indication for antiarrhythmic therapy is to reduce ventricular rate in atrial flutter or fibrillation. Rare forms of ventricular tachycardia appear to be DAD-mediated and respond to verapamil. Parenteral verapamil and diltiazem are approved for rapid conversion of PSVTs to sinus rhythm and for temporary control of rapid ventricular rate in atrial flutter or fibrillation. Oral verapamil may be used in conjunction with digoxin to control ventricular rate in chronic atrial flutter or fibrillation and for prophylaxis of repetitive PSVT Unlike adrenergic receptor antagonists, Ca + channel blockers have not been shown to reduce mortality after myocardial infarction. 

Although the primary clinical use for digoxin is in the treatment of CFIF, this agent also is used in cases of atrial flutter or fibrillation and paroxysmal atrial tachycardia. 

Digoxin is used to control the ventricular response rate in tachyarrhythmias such as atrial fibrillation and atrial flutter. In the setting of systolic heart failure and normal sinus rhythm, digoxin improves morbidity and decreases the frequency of hospitalizations for exacerbation of heart failure. The therapeutic range for digoxin is 0.8 to 2 ng/ml. ... 

Of the other 9 patients, 3 had immediate and definite ST-T wave changes, and the remaining 6 had no demonstrable changes. There are other reports of this interaction, " including one that describes sinus tachycardia and atrial flutter in 6 out of 18 patients taking digoxin after they were given pancuronium. ... 

With impaired heart function (heart failure or EF below 40%) digoxin or amiodarone Ablation therapy for recurrent atrial flutter... 

Digoxin (see p. 158) shortens the refractory period in atrial and ventricular myocardial cells while prolonging the effective refractory period and diminishing conduction velocity in Purkinje fibers. Digoxin is used to control the ventricular response rate in atrial fibrillation and flutter. At toxic concentrations, digoxin causes ectopic ventricular beats that may result in ventricular tachycardia and fibrillation. [Note This arrhythmia is usually treated with lidocaine or phenytoin.]... 

Roberts SA, Diaz C, Nolan PE, et al. Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter. Am J Cardiol 1993 72 567-573. 

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