European Journal of Clinical Pharmacology

, Volume 17, Issue 4, pp 243–250 | Cite as

Digoxin concentration in right atrial myocardium, skeletal muscle and serum in man: Influence of atrial rhythm

  • T. Jogestrand
Originals

Summary

Serum, right atrial myocardium and skeletal muscle collected from 32 adult patients undergoing open heart surgery were analyzed for digoxin by radioimmunoassay. Preoperatively 20 patients were in sinus rhythm and 12 were in atrial fibrillation. In patients with sinus rhythm, but not in patients with atrial fibrillation, there was a highly significant correlation between digoxin concentration in serum and right atrial myocardium, in skeletal muscle and right atrial myocardium, and in serum and skeletal muscle. The means and variances of the ratios right atrial myocardium/serum and right atrial myocardium/skeletal muscle were significantly higher in patients with atrial fibrillation than in those with sinus rhythm. This, plus the lack of difference in ratios skeletal muscle/serum between these groups of patients, indicate increased right atrial digoxin binding in atrial fibrillation in man. This conclusion is further supported by the finding of similar or higher digoxin concentration in right atrial myocardium than in left ventricular myocardium in atrial fibrillation (6 patients), and a lower digoxin concentration in right atrial myocardium than in left ventricular myocardium in sinus rhythm (3 patients).

Key words

digoxin atrial fibrillation digoxin concentrations in right atrium skeletal muscle serum sinus rhythm man 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Carroll PR, Gelbart A, O'Rourke MF, Shortus J (1973) Digoxin concentrations in the serum and myocardium of digitalised patients. Aust NZJ Med 3: 400–403Google Scholar
  2. Carruthers SG, Cleland J, Kelly JG, Lyons SM, McDevitt DG (1975) Plasma and tissue digoxin concentrations in patients undergoing cardiopulmonary bypass. Br Heart J 37: 313–320Google Scholar
  3. Coltart DJ, Howard M, Chamberlain D (1972) Myocardial and skeletal muscle concentrations of digoxin in patients on long-term therapy. Br Med J 2: 318–319Google Scholar
  4. Coltart DJ, Güllner HG, Billingham M, Goldman RH, Stinson EB, Kalman SM, Harrison DC (1974) Physiological distribution of digoxin in human heart. Br Med J 4: 733–736Google Scholar
  5. Ebert PA, Greenfield LJ, Austen WG (1963) The effect of increased serum potassium on the digoxin content of the canine heart. Bull. Johns Hopkins Hosp 112: 151–154Google Scholar
  6. Ejvinsson G (1978) Effect of quinidine on plasma concentrations of digoxin. Br Med J 1: 279–280Google Scholar
  7. Güllner HG, Stinson EB, Harrison DC, Kalman SM (1974) Correlation of serum concentrations with heart concentrations of digoxin in human subjects. Circulation 50: 653–655Google Scholar
  8. Haasis R, Larbig D, Stunkat R, Bader H, Seboldt H (1977) Determination of glycoside concentrations in human tissue by means of radioimmunoassay. Klin Wochenschr 55: 23–30Google Scholar
  9. Hald A (1960) Statistical Theory with Engineering Applications. John Wiley, New York, p 571Google Scholar
  10. Härtel G, Kyllänen K, Merikallio E, Ojala K, Manninen V, Reissell P (1976) Human serum and myocardium digoxin. Clin Pharmacol Ther 19: 153–157Google Scholar
  11. Jogestrand T (1978) Letter to the Editor: Digoxin binding in right atrium. Lancet 2: 1104Google Scholar
  12. Jogestrand T (1979) Digoxin binding in right atrium. J. molec. cell. Cardiology 11: Suppl. 2, 25 (abstract)Google Scholar
  13. Jusko WJ, Weintraub M (1974) Myocardial distribution of digoxin and renal function. Clin Pharmacol Ther 16: 449–454Google Scholar
  14. Karjalainen J, Ojala K, Reissell P (1974) Tissue concentrations of digoxin in an autopsy material. Acta Pharmacol. Toxicol. 34: 385–390Google Scholar
  15. Kuschinsky K, Lahrtz H, Lüllman H, Zwieten PA van (1967) Accumulation and release of3H-digoxin by guinea-pig heart muscle. Br J Pharmacol 30: 317–328Google Scholar
  16. Lichey J, Havestatt Ch, Weinmann J, Hasford J, Rietbrock N (1978) Human myocardium and plasma digoxin concentration in patients on long-term digoxin therapy. Int J Clin Pharmacol Biopharm 16: 460–462Google Scholar
  17. Lloyd BL, Taylor RR (1976) Influence of myocardial mechanical activity and coronary blood flow on myocardial digoxin uptake. Cardiovasc Res 10: 487–493Google Scholar
  18. Lloyd BL, Taylor RR (1978) The effect of heart rate on myocardial ouabain uptake and on the susceptibility to ouabain cardiotoxicity in the dog. Clin Exp Pharmacol Physiol 5: 171–179Google Scholar
  19. Malcolm A, Coltart J (1977) Editorial: Relation between concentrations of digoxin in the myocardium and in the plasma. Br. Heart J 39: 935–938Google Scholar
  20. Redfors A, Bertler Å, Schüller H (1973) The ratio between myocardial and plasma levels of digoxin in man. In Symposium on Digitalis. Gyldendal Norsk Forlag, Oslo, pp 265–269Google Scholar
  21. Reiffel JA, Leahey Jr EB, Drusin RE, Heissenbuttel RH, Lovejoy W, Bigger Jr JT (1979) A previously unrecognized drug interaction between quinidine and digoxin. Clin. Cardiol. 2: 40–42Google Scholar
  22. Rosen MR, Gelband H (1973) Effects of ouabain on canine purkinje fibers in situ or perfused with blood. J Pharmacol Exp Ther 186: 366–372Google Scholar
  23. Roth-Schechter BF, Okita GT, Anderson D, Richardson F (1970) Relationship among contraction, drug binding and positive inotropic action of digoxin. J Pharmacol Exp Ther 171: 249–255Google Scholar
  24. Smith TW, Butler VP, Haber E (1969) Determination of therapeutic and toxic serum digoxin concentration by radioimmunoassay. N Engl J Med 281: 1212–1216Google Scholar
  25. Snedecor GW (1956) Statistical methods. The Iowa State College Press, Ames, Iowa, pp. 96–99Google Scholar
  26. Su H, Grupp G, Farr WC (1972) Gross and subcellular uptake of tritiated digoxin in the normal and abnormal canine myocardium. Fed Proc 31: 583 (abstract)Google Scholar

Copyright information

© Springer-Verlag 1980

Authors and Affiliations

  • T. Jogestrand
    • 1
  1. 1.Department of Clinical Physiology and Thoracic SurgeryKarolinska HospitalStockholmSweden

Personalised recommendations