Absence of cardioversion-induced ventricular arrhythmias in patients with therapeutic digoxin levels

Ventricular Arrhythmias Induced hy Electrical Cardioversion in Digitalised Patients

“…therapeutic digoxin levels [12,13] were encouraging and the authors recommended that digitalised patients with out clinical or electrocardiographic evidence of digoxin toxicity could be safely cardioverted [12]. To the best of our knowledge our study is the first report of clinical experience with such guidelines.…”

“…In addition factors such as electrolyte imbalance, the degree of myo cardial dysfunction and 'irritability' may facilitate an interaction between therapeutic digitalisation and elec tric shock in the clinical setting. Although the clinical studies of Ditchey and Karliner [ 12] and Mann et al [ 13] suggested that such an interaction did not occur, both studies involved small numbers and both looked at counts of ventricular ectopics in the hours before and after cardioversion, thus they may have missed transient immediate post-cardioversion arrhythmias, especially as the holter monitors had to be reconnected after cardio version [13].…”

“…Therefore we now report our results with 50 consecutive cardioversions in digitalised patients who showed no clinical or ECG evidence of toxicity com pared to 33 cardioversions performed in non-digitalised patients over the same time period. Because the inci dence of actual life-threatening arrhythmia following cardioversion is rare, the main endpoint of this study was the occurrence of lesser ventricular arrhythmia -the approach used in previous clinical [7,12,13] and animal studies [8][9][10][11]. …”

“…How ever, many of the patients reported in the clinical studies had electrocardiogrphic (ECG) evidence of digoxin tox icity [3,5,6] and toxic doses of digoxin were often used in the animal studies [9], therefore the relationship between 'therapeutic' digoxin levels and electic counter shock remained unclear. With the availability of serum digoxin concentrations, two recent experimental [10,11] and two clinical studies [12,13] found an absence of cardioversion-induced arrhythmias in the presence of …”

Paediatric cardiac catheterization: innovations

“…The occurrence and frequency of arrhythrnias and conduction abnormalities depend on multiple factors: presence and type of pre-cardioversion arrhythmias, cardiac disease, metabolic derangements, digitalis toxicity, and shock strength. [70][71][72][73][74][75] Morphological and function damage A number of studies have demonstrated that electrical countershock can produce morphological and functional derangements. 76-79 The extent of macroscopic and microscopic evidence of necrosis, ECG changes and serum enzymes changes (CK-BB), is related to the intensity of the electrical shock and inversely to the time between shocks.…”