Re: bummer/digoxin

[Guest guest]

Trudy,

I'm happy to hear that your pet survived, but sorry to hear that your pet's

sickness has had such a shattering effect on you. I know from firsthand

experience how upsetting a sick pet can be, but you do have to take care of

yourself, too! I guess you have figured that out by now.

If you are still a paroxysmal afibber, it might seem that the Digoxin

prescription might be inappropriate and a bit premature. My previous

cardiologist told me that Digoxin is inappropriate for paroxysmal afibbers

because it can actually encourage the development of permanent afib. He said

it should be taken only by permanent afibbers. My brother would testify that

the drug is very effective for permanent affibers because it has really

helped him. However, he had already been long in permanent afib by the time

he started the Digoxin. The drug has been great for him, controlling his

afib to the point that he lives a normal life.

Apparently there is some disagreement among doctors on the efficacy of

Digoxin for paroxysmal afib sufferers, but you might want to ask your doctor

about the issue of encouraging afib.

in sinus in Seattle

[Guest guest]

Trudy,

I'm happy to hear that your pet survived, but sorry to hear that your pet's

sickness has had such a shattering effect on you. I know from firsthand

experience how upsetting a sick pet can be, but you do have to take care of

yourself, too! I guess you have figured that out by now.

If you are still a paroxysmal afibber, it might seem that the Digoxin

prescription might be inappropriate and a bit premature. My previous

cardiologist told me that Digoxin is inappropriate for paroxysmal afibbers

because it can actually encourage the development of permanent afib. He said

it should be taken only by permanent afibbers. My brother would testify that

the drug is very effective for permanent affibers because it has really

helped him. However, he had already been long in permanent afib by the time

he started the Digoxin. The drug has been great for him, controlling his

afib to the point that he lives a normal life.

Apparently there is some disagreement among doctors on the efficacy of

Digoxin for paroxysmal afib sufferers, but you might want to ask your doctor

about the issue of encouraging afib.

in sinus in Seattle

[Guest guest]

> If you are still a paroxysmal afibber, it might seem that the

Digoxin

> prescription might be inappropriate and a bit premature. My

previous

> cardiologist told me that Digoxin is inappropriate for paroxysmal

afibbers

> because it can actually encourage the development of permanent afib.

Yikes. I'm supposed to take this until I see the doctor on Monday.

I am still (I hope) paroxsymal, although this is a much longer event

than any I have had since about a year ago when I first was diagnosed

with afib. Is there any info on how much time one has, if any,

before it causes a problem? How does it encourage permanent afib?

I think I will call in tomorrow in the daytime and ask whichever

doctor is on call about this.

I'm assuming it is the digoxin that has caused me to feel like there

is basically nothing wrong, as long as I don't exert too much

effort. I would have sworn I was in sinus when I was laying around

on the couch, until I took my pulse.

Thanks for any info.

Trudy

[Guest guest]

> If you are still a paroxysmal afibber, it might seem that the

Digoxin

> prescription might be inappropriate and a bit premature. My

previous

> cardiologist told me that Digoxin is inappropriate for paroxysmal

afibbers

> because it can actually encourage the development of permanent afib.

Yikes. I'm supposed to take this until I see the doctor on Monday.

I am still (I hope) paroxsymal, although this is a much longer event

than any I have had since about a year ago when I first was diagnosed

with afib. Is there any info on how much time one has, if any,

before it causes a problem? How does it encourage permanent afib?

I think I will call in tomorrow in the daytime and ask whichever

doctor is on call about this.

I'm assuming it is the digoxin that has caused me to feel like there

is basically nothing wrong, as long as I don't exert too much

effort. I would have sworn I was in sinus when I was laying around

on the couch, until I took my pulse.

Thanks for any info.

Trudy

[Guest guest]

I went web grubbing and found the following about digoxin.

Falk, R. H. and J. I. Leavitt (1991). " Digoxin for atrial

fibrillation: a drug whose time has gone? " ls of Internal

Medicine 114: 573-575.

Short review paper. In patients with atrial fibrillation, studies

suggest that digoxin is a poor drug for controlling heart rate during

exertion, has little or no effect in terminating the arrhythmia, and

may occasionally aggravate paroxysmal atrial fibrillation.

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

EMBBS Emergency Medicine and Primary Care WWW site

http://www.embbs.com/index.html

The use of digoxin to control atrial fibrillation is based on the

drug's ability to prolong the effective refractory period of the AV

node (increases AV block). It is therefore able to slow the

progression of atrial impulses to the ventricles, slowing the heart

rate. Digoxin is not associated with an increased incidence of

conversion to sinus rhythm from atrial fibrillation. If such

conversion is later deemed necessary, caution needs to be exercised

as both commonly used techniques are risky in patients on digoxin.

Quinidine reduces tissue and protein binding, resulting in an

elevated digoxin level, and also reduces the drug's renal

elimination. Electrical cardioversion should be used with extreme

caution in digitalized patients as conduction abnormalities and

dysrhythmias frequently result.

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

Web site of the American Heart Association

Digoxin can also occasionally interfere with the normal heartbeat,

causing irregular heartbeats or skipped beats.

[Guest guest]

I went web grubbing and found the following about digoxin.

Falk, R. H. and J. I. Leavitt (1991). " Digoxin for atrial

fibrillation: a drug whose time has gone? " ls of Internal

Medicine 114: 573-575.

Short review paper. In patients with atrial fibrillation, studies

suggest that digoxin is a poor drug for controlling heart rate during

exertion, has little or no effect in terminating the arrhythmia, and

may occasionally aggravate paroxysmal atrial fibrillation.

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

EMBBS Emergency Medicine and Primary Care WWW site

http://www.embbs.com/index.html

The use of digoxin to control atrial fibrillation is based on the

drug's ability to prolong the effective refractory period of the AV

node (increases AV block). It is therefore able to slow the

progression of atrial impulses to the ventricles, slowing the heart

rate. Digoxin is not associated with an increased incidence of

conversion to sinus rhythm from atrial fibrillation. If such

conversion is later deemed necessary, caution needs to be exercised

as both commonly used techniques are risky in patients on digoxin.

Quinidine reduces tissue and protein binding, resulting in an

elevated digoxin level, and also reduces the drug's renal

elimination. Electrical cardioversion should be used with extreme

caution in digitalized patients as conduction abnormalities and

dysrhythmias frequently result.

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

Web site of the American Heart Association

Digoxin can also occasionally interfere with the normal heartbeat,

causing irregular heartbeats or skipped beats.

[Guest guest]

Expanded abstract from medline:

Ann Intern Med 1991 Apr 1;114(7):573-5 Related Articles, Books,

LinkOut

Comment in:

Ann Intern Med. 1991 Jun 1;114(11):993

Digoxin for atrial fibrillation: a drug whose time has gone?

Falk RH, Leavitt JI.

Boston City Hospital, Massachusetts.

For over 200 years digitalis compounds have been used to treat atrial

fibrillation. The rapid ventricular response to atrial fibrillation

is frequently treated with digoxin to produce a controlled heart

rate. Digoxin has also been proposed as a treatment for terminating

recent-onset atrial fibrillation, for maintaining sinus rhythm after

an episode of atrial fibrillation, and as prophylactic therapy in

patients with paroxysmal atrial fibrillation to prevent excessive

tachycardia during a paroxysm. Perhaps because it has been used for

so long, few of these indications have been studied scientifically

until recently. Studies now suggest that in patients with atrial

fibrillation, digoxin is a poor drug for controlling heart rate

during exertion, has little or no effect in terminating the

arrhythmia, and may occasionally aggravate paroxysmal atrial

fibrillation. Despite adequate digitalization, the heart rate at the

onset of a paroxysm of fibrillation in patients receiving the drug

does not differ from the heart rate in patients not receiving it.

This article discusses the current role of digoxin in the management

of patients with chronic, recent-onset, or paroxysmal atrial

fibrillation.

PMID: 2001090 [PubMed - indexed for MEDLINE]

[Guest guest]

Expanded abstract from medline:

Ann Intern Med 1991 Apr 1;114(7):573-5 Related Articles, Books,

LinkOut

Comment in:

Ann Intern Med. 1991 Jun 1;114(11):993

Digoxin for atrial fibrillation: a drug whose time has gone?

Falk RH, Leavitt JI.

Boston City Hospital, Massachusetts.

For over 200 years digitalis compounds have been used to treat atrial

fibrillation. The rapid ventricular response to atrial fibrillation

is frequently treated with digoxin to produce a controlled heart

rate. Digoxin has also been proposed as a treatment for terminating

recent-onset atrial fibrillation, for maintaining sinus rhythm after

an episode of atrial fibrillation, and as prophylactic therapy in

patients with paroxysmal atrial fibrillation to prevent excessive

tachycardia during a paroxysm. Perhaps because it has been used for

so long, few of these indications have been studied scientifically

until recently. Studies now suggest that in patients with atrial

fibrillation, digoxin is a poor drug for controlling heart rate

during exertion, has little or no effect in terminating the

arrhythmia, and may occasionally aggravate paroxysmal atrial

fibrillation. Despite adequate digitalization, the heart rate at the

onset of a paroxysm of fibrillation in patients receiving the drug

does not differ from the heart rate in patients not receiving it.

This article discusses the current role of digoxin in the management

of patients with chronic, recent-onset, or paroxysmal atrial

fibrillation.

PMID: 2001090 [PubMed - indexed for MEDLINE]

[Guest guest]

Here's one that seesm to indicate digoxin can prolong afib.

Ann Intern Med 1987 Apr;106(4):503-6

Digoxin for converting recent-onset atrial fibrillation to sinus

rhythm. A randomized, double-blinded trial.

Falk RH, Knowlton AA, Bernard SA, Gotlieb NE, Battinelli NJ.

Study Objective: to determine whether digoxin is effective in

converting atrial fibrillation of recent onset to normal sinus

rhythm. Design: randomized, double-blinded, placebo-controlled trial

with a maximum 18-hour treatment period. Setting: emergency room and

medical floors of a non-referral city hospital. Patients: consecutive

sample of 36 patients with atrial fibrillation of 7 days' duration or

less, not on digitalis glycoside or anti-arrhythmic agents, with

ventricular rate between 85 to 175 beats/min, without evidence of

heart failure, acute myocardial infarction, unstable angina,

preexcitation syndrome, thyrotoxicosis, hypokalemia, renal

impairment, or severe metabolic disturbances. Interventions: digoxin

solution in capsules or identical placebo, given in doses of 0.6,

0.4, 0.2, and 0.2 mg, at 0, 4, 8, and 14 hours, respectively, or

until conversion to sinus rhythm, whichever occurred first.

Continuous electrocardiographic recording by Holter monitor.

Measurements and Main Results: nine of eighteen patients receiving

digoxin and 8 of 18 receiving placebo had a return to sinus rhythm

within 18 hours of study entry (95% confidence interval for the

difference in proportions, -11% to 22%). Mean time to conversion was

5.1 hours in the digoxin group and 3.3 in the placebo group (95% Cl, -

3.6 to 7.0 hours). Conclusions: spontaneous reversion to sinus rhythm

is common in patients with atrial fibrillation of recent onset.

Digitalization was not shown to affect the likelihood of reversion to

sinus rhythm, and thus cannot be recommended for this purpose in

patients with atrial fibrillation.

[Guest guest]

Trudy:

I've been on digoxin (0.125 mg qd) for more than 10 years and my

paroxysmal AF has not become permanent. (In fact, for no apparent

reason the time between episodes of AF has recently grown longer.) I

do not take digoxin for the purpose of converting to NSR, because my

AF converts spontaneously. Rather, I take it to help with rate

control. After reading all the anti-digoxin articles, my

cardiologist agreed that I could try to go off it last Spring. I

felt much worse without it and in fact, I went in to AF much more

easily and more often without it. I'm not suggesting that this is

for sure the right drug for you, only that from my experience there

is no cause for immediate alarm.

Hope you're feeling better soon.

Warmly, Lee

>

> I haven't taken digoxin before - any thoughts on this? Any pats on

> the head, sigh. Thanks,

>

> Trudy

[Guest guest]

In a message dated 9/28/2001 11:03:48 PM Pacific Daylight Time,

trudyjh@... writes:

<< I'm assuming it is the digoxin that has caused me to feel like there

is basically nothing wrong, as long as I don't exert too much

effort. I would have sworn I was in sinus when I was laying around

on the couch, until I took my pulse.

>>

Trudy,

I don't think that taking Digoxin for a short while would cause you to be in

permanent afib. I asked my cardiologist about two years ago if I could take

Digoxin instead of Verapamil because my brother had taken Digoxin very

successfully for about ten years. My cardiologist responded that while

Digoxin would be very appropriate for my brother, who is in permanent afib,

it would not be appropriate for me because I am still paroxysmal after nearly

eighteen years of afib. He said that Digoxin has a proarrhythmic aspect

which can actually encourage the development of afib. I received the

impression, though, that one would have to take the drug over a considerable

period of time to see the development of permanent afib. Also, I have since

read messages and heard comments from people who have taken Digoxin but have

not developed permanent afib. I think that there is disagreement among

doctors on this issue.

Probably not enough research has been done to categorically prove the effects

of Digoxin either way because Digoxin is such an old drug and usually old,

tried-and-true drugs don't inspire much research. It is basically derived

from a chemical (atropine?) in the common foxglove plant which springs forth

spontaneously in Seattle gardens. Because the chemical is inherently toxic

at excessive doses, one's digitalis blood level must be frequently monitored

at first to be sure the Dig level is not too high. Despite its toxic

potential, however, I think it seems to be one of the safest drugs for

arrhythmia if it is taken according to directions and carefully monitored.

Digoxin's relative safety is the reason I asked my doctor if I could take it.

After reading horror stories about Verapamil, I wanted to discontinue that

drug.

Digoxin has been a life-saver and life-transformer for my brother, who is in

permanent afib. Twelve years ago afib had completely destroyed his quality

of life. He couldn't eat, sleep, walk, or perform any kind of physical

exertion without extreme shortness of breath and exhaustion. During a visit

to a gastroenterologist (my brother thought his stomach was the source of his

problem), the doctor diagnosed afib from the door of the examining room

because he could see the jugular vein in my brother's neck pulsating wildly

in the erratic rhythm of afib. The doctor prescribed a loading dose of

Digitalis (a higher than normal dose taken at the beginning to rapidly

achieve a sufficiently high dig level), and within two days my brother was

feeling absolutely normal. Now on Digitalis and Atenolol 25 m.g. daily, my

brother leads an absolutely normal life with a physical activity level that

is far above normal. Although he is eleven years older than I, I have

trouble keeping up with him! He has had no ill effects from the Digitalis

and only has to have his blood level monitored once a year now, although

initially it was monitored frequently. He regards Digitalis as a miracle

drug because it restored his life to him. However, the doctor estimated at

the time of that initial diagnosis of afib, that my brother had been in afib

for an unknown but very long time. Therefore, he wouldn't even think of

trying cardioversion or any other kind of non-drug procedure. Also, the

doctor probably chose Digitalis because my brother was already in permanent

afib and because that doctor tends to be very conservative in prescribing

drugs. He told my brother that there were other, newer but more dangerous

drugs (we know about those, don't we? :-) he could give him, but he

preferred to try the more proven and safer drug first. My brother has never

seen a cardiologist but has continued with this gastroenterologist as his

primary care doctor because the doctor has proven very successful in solving

my brother's problems. (I am now seeing the same doctor in an attempt to

solve my stomach woes.)

I certainly didn't mean to cause you panic, Trudy, when I encouraged you to

question your doctor about the effects of Digoxin. I don't think you have

any reason to be concerned in the short term, but I just thought it might be

a good idea to do some research before you continue the drug over the long

term. I'm sure the drug will be helpful in the short term as you are already

seeing the same effects the drug produced in my brother. You say that the

drug has mitigated the symptoms of afib for you, and that's what it did for

my brother. He now has no awareness that he is in afib and never thinks

about afib except when I am whining about my afib problems. My advice is to

give the drug a try but to be cautious and curious as one should be about all

drugs, I think. Don't panic because you are taking what is probably one of

the most proven, safest drugs around.

Best wishes,

in sinus in Seattle

[Guest guest]

Hi group...

I have to come to the defense of digoxin too. I was first diagnosed with AF

about four years ago. I was put on digoxin exclusively for the first year

and stayed in NSR and had no side effects for that entire year. Towards the

end of the year I started getting severe PVC/PAC's which would send me into

AF. The doctor wanted to start me on beta blockers but I had done some

reading on digoxin and my condition and found that digoxin could deplete the

body of magnesium which could cause the PVC/PAC's. I started on magnesium

and within a day I was no longer having the arrhythmias. The NSR

blissfulness lasted another four months and then the PVC/PAC's started up

again and the magnesium would no longer control the arrhythmias so I started

on beta blockers. That was the start of my downwards spiral with AF. The

beta blockers eventually failed and I tried one drug after another to which I

had a couple of serious reactions to. In the end I went back to taking just

the beta blocker since they had the least amount of side effects of all the

drugs.

In June of this year I was at my all time low. I was going into AF every

other day and having severe PVC/PAC's when I wasn't in AF. My

electrophysiologist gave me the options of having a catheter ablation or dual

chamber pacemaker. I decided to get a second opinion and made an appointment

with a well known electrophysiologist in Seattle. Unfortunately I couldn't

get an appointment with him until the second week of September. Since I was

so desperate I decided on my own to take digoxin along with the beta blockers

that I was currently on. After about a week of taking the digoxin along with

the beta blockers the PVC/PAC's started quieting down and the length of time

between AF episodes went from every other day to once a week. Now they have

lengthened to once every three weeks with no arrhythmias until a couple of

days before I go into AF. I unfortunately missed the appointment with the

new electrophysiologist because I got caught down in Orlando and couldn't get

home when the Trade Towers were hit.

From the reading I have done on digoxin, it supposedly can shorten the PR

interval which can cause a reentrant circuit and cause AF. I already have a

short PR interval and this is probably one of the reasons my

electrophysiologist didn't want me on it. I have also read that digoxin has

some effect on the parasympathetic system which may be good for those of us

that have the vagal form of AF. My theory why the digoxin and beta blockers

are working for me is that the beta blockers modify the adrenergic system and

the digoxin modifies the parasympathetic (vagal) system. My feeling is that

if both systems are not balanced then the problems with the arrhythmias can

occur.

Just my .02 cents worth.....

Diane Porter

Milton, WA

[Guest guest]

I am really wigged out/depressed. I went back into sinus late

Friday, but I have had two more episodes this noon and now. I think

todays are for sure related to digestion. Like now I will slip into

sinus for a short while, then burp and my pulse gets and stays

irregular for some time. I don't know if today's are afib or

frequent extra beats.

I don't know why I'm not handling this well. I think because I know

I was in afib Friday (ekg) whereas for quite some time I have instead

been having frequent extra beats per minute events. afib scares me

more, although the immediate physical effects are actually less,

because it raises the spectre of permanence. Plus, the doc put me on

coumadin. So this is going in the wrong direction.

Plus three episodes in three days...although when I had indigestion-

related ones when I saw her in July I was having multiple things.

Well, this is a major whine.