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Revista de salud publica del Paraguay

versión On-line ISSN 2307-3349

Resumen

SEQUEIRA, Orlando Robert et al. Plasma levels of digoxin in patients with atrial fibrillation and its relation to alterations of repolarization and ventricular arrhythmias. Hospital de Clínicas, FCM-UNA, Paraguay. Rev. salud publica Parag. [online]. 2019, vol.9, n.1, pp.65-72. ISSN 2307-3349.  https://doi.org/10.18004/rspp.2019.junio.65-72.

Introduction:

Atrial fibrillation is the most common sustained arrhythmia in the field of internal medicine, with prevalence of 1% and risk of life 25% approximately, after 40 years. Previous studies to examine the safety of digoxin in patients with atrial fibrillation have as limitation, the lack of determinations of the serum concentration of this drug, necessary to define a possible relationship between dose and response.

Methodology:

Prospective, descriptive, cross-sectional study with analytical component, the value of digoxin in blood was analyzed the types of cardiac arrhythmias concomitant with atrial fibrillation, risk factors, daily dose of digoxin received, in ambulatory patients from the Division of Cardiovascular Medicine-Hospital de Clínicas, from July to October 2018.

Results:

Of 48 patients, 5 (10%) had a digoxinemia greater than 1.2 ng / ml, and 43 (90%) patients had digoxinemia less than 1.2 ng / ml. Of the total patients, 18 (38%) patients received a daily dose of 0.25 mg and 30 (62%) patients a daily dose of less than 0.25 mg. The most frequent conduction system disorder found was the alteration of repolarization (20%), the presence of Q waves (9%), the alterations of repolarization with ventricular premature beats and the presence of negative T waves (7%), the presence of complete blockage of the right bundle branch and left anterior hemiblock (5%). A significant association was found between the dose of digoxin and digoxinaemia in the normal range (p = 0.03); A significant association was also found between high digoxinemia and alterations in repolarization (p = 0.0005). An association was found between high digoxinemia and the presence of a dilated left atrium (p = 0.001 OR: 0.8 CI 0.6 - 1.03).

Conclusion:

The majority of patients presented digoxinemia in a safety range, that is, less than 1.2 ng. The majority of patients received a dose of less than 0.25 mg. There is a significant association between digoxin dose and serum digoxinemia. We also found a significant association between high digoxinemia and alterations in repolarization and the presence of a dilated left atrium.

Palabras clave : Atrial fibrillation; Ventricular arrhythmias; Left atrial dilatation..

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