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Digoxin Use in Cardiac Amyloidosis.
Joseph P Donnelly1, Brett W Sperry2, Andrej Gabrovsek3
1Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Chemistry, The Scripps Research Institute, La Jolla, California.
The American Journal of Cardiology
|August 18, 2020
Summary
Digoxin may be a viable option for managing atrial fibrillation and heart failure in cardiac amyloidosis (CA). While 12% experienced toxicity, careful patient selection and monitoring are key for safe use.
Area of Science:
- Cardiology
- Pharmacology
- Amyloidosis Research
Background:
- Cardiac amyloidosis (CA) presents limited therapeutic options for atrial fibrillation rate control and heart failure.
- Digoxin use is often avoided in CA due to concerns of increased sensitivity and toxicity.
Purpose of the Study:
- To evaluate the safety and efficacy of digoxin in patients with cardiac amyloidosis.
- To determine the incidence of digoxin-related arrhythmias and toxicity in this patient population.
Main Methods:
- Retrospective study of 69 cardiac amyloidosis patients (ATTR and AL types) with ≥7 days of digoxin use.
- Analysis of medical records to identify suspected digoxin-related adverse events.
- Stratification based on amyloid precursor protein-transthyretin (ATTR) and immunoglobulin light chain (AL) subtypes.
Main Results:
- Digoxin was used for rate control (64%) and heart failure management (36%).
- Suspected digoxin-related arrhythmias or toxicity occurred in 12% of patients.
- No deaths were directly attributed to digoxin; 11 patients died from progressive cardiac amyloidosis.
Conclusions:
- Digoxin can be a therapeutic option for rate and symptom control in select patients with AL-CA and ATTR-CA.
- Rigorous patient selection and close monitoring are essential for safe digoxin administration in cardiac amyloidosis.
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