Recognition of digitalis intoxication in the presence of atrial fibrillation: Analysis of 167 cases

Summary

995 patients with atrial fibrillation were treated with digitalis. Of them 167 developed digitalis intoxication in the form of various arrhythmias, and 20 (12%) died of severe intoxication. The occurrence of arrhythmia among rheumatic patients was 20.82%, while among coronary heart disease 10.04%. The types of arrhythmias appeared in the order of following sequences: slow ventricular rate with junctional escapes, complete or almost complete entrance block in AVN, subsequently followed by non-paroxysmal junctional tachycardia and that coexisting with ventricular premature beat in the form of bigeminy, then Wenckebach’s type of exit block, bidirectional tachycardia with possible coexistence of right or left BBB. In addition, various forms of ventricular premature beats, mostly in coupled rhythm occurred.

The identification of digitalis intoxication with atrial fibrillation was illustrated. The characteristics of ECG in junctional escapes, junctional tachycardia and bidirectional tachycardia, etc., were described to facilitate prompt recognition.