Acute Digitoxin Intoxication Treated by Intracardiac Pacemaker: Experience in Sixty-Eight Patients

Abstract

Out of 124 patients who had taken massive doses of digitoxin in attempted suicide, emergency endocardial pacing was performed in the 68 with the worst prognosis. The mortality (13%) in the 124 patients compared favorably with the mortality (20%) in a previous series of 70 similar patients none of whom were paced. Sixteen (23%) of the 68 paced patients died. The causes of death were: asystole (two); cardiogenic shock (two); septicemia (one); and ventricular fibrillation (eleven). Ventricular fibrillation occurred during introduction of the pacing catheter in two patients, as a result of electrode displacement in these patients, because of premature withdrawal of the catheter in one patient, and for no detectable reason, during normally proceeding pacing, in five patients. Endocardial pacing has a place in the emergency treatment of massive digitoxin poisoning. Its chief hazards are mechanical, and one of the commonest is electrode displacement.

Safety of Transvenous Temporary Cardiac Pacing in Patients with Accidental Digoxin Overdose and Symptomatic Bradycardia

“…However, it had been reported that this procedure might be complicated by fatal arrhythmias and resulted in a less favorable outcome in patients with acute digitalis intoxication caused by attempted suicide [1, 2]. Though this complication had not been reported in similar patients with accidental digoxin overdose, it might possibly restrict the recommendation of this procedure in such patients.…”

“…In the literature, it had been reported that TCP might be associated with fatal arrhythmias in patients with acute intoxication caused by attempted suicide [1, [2]. In the prospective study of Bismuth et al [1], 16 out of 17 patients with acute digitoxin intoxication that died had received TCP.…”

“…Studies regarding the effects of TCP in patients with acute digitalis intoxication showed adverse results [1, 2]. The safety of TCP has never been evaluated in patients with accidental digoxin overdose complicated by symptomatic bradycardia.…”

“…In the prospective study of Bismuth et al [1], 16 out of 17 patients with acute digitoxin intoxication that died had received TCP. A total of 68 patients underwent this procedure, 16 (23%) of whom died.…”

Cardiac pacing in patients with familial dysautonomia

“…Such a response might occur among patients with a diseased heart [28] or in the setting of drug intoxication [11], but seems very less likely among untreated young patients free from intrinsic, structural myocardial disease.…”