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Digitalis therapy is associated with higher comorbidities and poorer prognosis in patients undergoing ablation of atrial arrhythmias: data from the German Ablation Registry

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Abstract

Background

Digitalis glycosides are employed for rate control of atrial fibrillation. Recent studies suggested potential harmful effects of digitalis monotherapy and combination with antiarrhythmic drugs. The aim of the present study was to assess the prevalence and potential impact of digitalis therapy on outcome in patients undergoing catheter ablation of supraventricular arrhythmias.

Methods and results

The German Ablation Registry is a nationwide, prospective registry with a 1-year follow-up investigating 12,566 patients receiving catheter ablations of supraventricular arrhythmias in 52 German centres. The present analysis focussed on pharmacotherapy in 8608 patients undergoing catheter ablation of atrial tachycardia, atrial fibrillation, or atrial flutter. Patients receiving digitalis therapy (n = 417) were older and presented a significantly increased prevalence of comorbidities including coronary artery disease, heart failure, diabetes, and pulmonary disease. One-year mortality was significantly higher in digitalis-treated patients (4.7% vs. 1.3%, p < 0.001), most strikingly in patients undergoing ablation of atrial flutter. This effect was maintained after adjustment for important risk factors. Similar results were obtained for as the combined endpoint of death, myocardial infarction, stroke and major bleeding (6.6% vs. 2.7%, p < 0.001), and non-fatal rehospitalisations (54.1% vs. 45.1%, p = 0.001).

Conclusion

In the present study of patients undergoing catheter ablation of supraventricular arrhythmias, an association of digitalis therapy with increased mortality and an increased rate of other severe adverse events were observed. The results from this ‘real-life’ registry are consistent with previously published studies. However, whether digitalis therapy promotes a poorer prognosis or may just serve as a marker for this aspect cannot be thoroughly interpreted.

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Author information

Author notes

  1. Burghard Schumacher

    Present address: Westpfalz-Klinikum, Kaiserslautern, Germany

Authors and Affiliations

  1. Clinic for Cardiology II - Electrophysiology, University of Münster, Münster, Germany

    Gerrit Frommeyer & Lars Eckardt

  2. Department of Cardiology, Klinikum Coburg, Coburg, Germany

    Johannes Brachmann

  3. Klinik für Allgemeine Innere Medizin-Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban und im Friedrichshain, Berlin, Germany

    Hüseyin Ince

  4. Praxisklinik Herz und Gefäße Dresden, Dresden, Germany

    Stefan G. Spitzer

  5. Department of Cardiology, University Hospital, Heidelberg, Germany

    Dierk Thomas

  6. Department of Electrophysiology, Heart Center University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Stephan Willems

  7. Herz- und Gefäßklinik, Bad Neustadt/Saale, Germany

    Burghard Schumacher

  8. Kardiologische Gemeinschaftspraxis Saalkreis, Salzatal, Germany

    Petra Schirdewahn

  9. Department of Cardiology, Internistisches Klinikum München Süd, Munich, Germany

    Thorsten Lewalter

  10. Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany

    Matthias Hochadel & Jochen Senges

  11. Abteilung für Kardiologie, Universitätsmedizin Rostock, Rostock, Germany

    Hüseyin Ince

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  1. Gerrit Frommeyer
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Corresponding author

Correspondence to Gerrit Frommeyer.

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Conflict of interest

D.T. reports receiving lecture fees/honoraria from Bayer Vital, Boehringer Ingelheim Pharma, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Pfizer Pharma, Sanofi-Aventis, St. Jude Medical and ZOLL CMS. T.L. reports modest speaker honoraria from Medtronic, Biotronik and Boston Scientific. All the other authors declared no conflict of interest related to this study.

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Frommeyer, G., Brachmann, J., Ince, H. et al. Digitalis therapy is associated with higher comorbidities and poorer prognosis in patients undergoing ablation of atrial arrhythmias: data from the German Ablation Registry. Clin Res Cardiol 108, 1083–1092 (2019). https://doi.org/10.1007/s00392-019-01442-w

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