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1、DigoxinDelaysRecoveryFromTachycardia-InducedElectricalRemodelingoftheAtriaRobertG.Tieleman,MD;YuriBlaauw,MD;IsabelleC.VanGelder,MD,PhD;CeesD.J.DeLangen,PhD;PieterJ.deKam,MSc;JanG.Grandjean,MD,PhD;KornelisW.Patberg,MD;KlaasJ.Bel,BSc;MauritsA.Allessie,MD,Ph
2、D;HarryJ.G.M.Crijns,MD,PhDBackgroundÐAtrialfibrillation(AF)induceselectricalremodeling,whichisthoughttoberesponsibleforthelowsuccessrateofantiarrhythmictreatmentinAFoflongerduration.Electricalremodelingseemstoberelatedtotachycardia-inducedintracellularcal
3、ciumoverload.Duetoitsvagomimeticaction,digoxiniswidelyusedtocontroltheventricularrateduringAF,butitalsoincreasesintracellularcalcium.Onthebasisofthesecharacteristics,wehypothesizedthatdigoxinwouldaggravatetachycardia-inducedelectricalremodeling.Methodsand
4、ResultsÐWeanalyzedtheatrialeffectiverefractoryperiod(AERP)atcyclelengthsof430,300,and200msduring24hoursofrapidatrio/ventricular(300/150bpm)pacingin7chronicallyinstrumentedconsciousgoatstreatedwithdigoxinorsaline.Digoxindecreasedthespontaneousheartratebuth
5、adnoothereffectsonbaselineelectrophysiologicalcharacteristics.Inadditiontoamoderateincreaseintherateofelectricalremodelingduringrapidpacing,digoxinsignificantlydelayedtherecoveryfromelectricalremodelingaftercessationofpacing(at430,300,and200ms:P50.001,P50
6、.0015,andP50.007,respectively).ThiswasparalleledbyanincreasedinducibilityanddurationofAFduringdigoxin.MultivariateanalysisrevealedthatbothashortAERPandtreatmentwithdigoxinwereindependentpredictorsofinducibility(P50.001andP50.03,respectively)andduration(P5
7、0.001forboth)ofAF.ConclusionsÐDigoxinaggravatestachycardia-inducedatrialelectricalremodelinganddelaysrecoveryfromelectricalremodelinginthegoat,whichincreasestheinducibilityanddurationofAF.(Circulation.1999;100:1836-1842.)KeyWords:fibrillationnpacingnremod
8、elingndigoxinncalciumnnervoussystem,autonomicDownloadedfromhttp://ahajournals.orgbyonAugust6,2018Atrialfibrillation(AF)leadstoshorteningoftheatrialintracellularcalciumconcentrationincreases.8Onthebasisofrefractorype
