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Impact of Abnormal Potassium on Arrhythmia Risk During Pediatric Digoxin Therapy

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Abstract

Digoxin is used in children with heart failure and tachyarrhythmia. Its use in patients with single ventricle anatomy has increased following evidence of improved interstage survival after the Norwood procedure. Digoxin has a narrow therapeutic window and may alter serum potassium balance, inducing arrhythmias. We hypothesized digoxin use in the setting of abnormal serum potassium levels is associated with arrhythmias. We reviewed all patients ≤ 18 years who received digoxin while admitted at our institution from 2014 to 2021. Admissions < 2 nights were excluded. We compared patients with a hemodynamically significant arrhythmia to those without. We performed adjusted mixed-effects logistic regression with arrhythmia as the outcome variable and potassium status as the predictor variable; adjusting for weight, route of digoxin administration, digoxin indication, serum creatinine, and number of interacting drugs prescribed. Abnormal potassium was defined as serum levels < 3.5 mmol/L or > 6.0 mmol/L. There were 268 encounters in 171 patients. Potassium levels were abnormal in 75.5% of patients who experienced an arrhythmia during digoxin administration, compared to 42.6% who did not (p < 0.001). Odds of arrhythmia was 138% higher in patients with abnormal potassium receiving digoxin (AOR = 2.38, 95% CI 1.07–5.29, p = 0.03). Receiving intravenous digoxin was also associated with a 7.35 odds of cardiac arrhythmia (AOR 7.35, p = 0.006, 95% CI 1.79–30.26). Odds of arrhythmia is increased during digoxin administration when pediatric patients have abnormal potassium levels. Vigilant attention to potassium levels is essential to prevent adverse outcomes during digoxin therapy.

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Abbreviations

AOR:

Adjusted odds ratio

CI:

Confidence interval

IQR:

Interquartile range

OR:

Odds ratio

STRIDE:

Stanford’s Translational Research Integrated Database Environment

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Acknowledgements

We thank Dr. Rita Popat for her feedback on the study proposal and research methodology and the patients who made this study possible.

Funding

This work was supported by research funding from Stanford University School of Medicine.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA

    Vongai Christine Mlambo, Claudia A. Algaze & R. Thomas Collins II

  2. Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA

    Claudia A. Algaze, Kwai Mak & R. Thomas Collins II

  3. Division of Pediatric Cardiology, University of Kentucky College of Medicine, Lexington, KY, USA

    R. Thomas Collins II

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  1. Vongai Christine Mlambo
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  2. Claudia A. Algaze
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  3. Kwai Mak
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  4. R. Thomas Collins II
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Correspondence to R. Thomas Collins II.

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Mlambo, V.C., Algaze, C.A., Mak, K. et al. Impact of Abnormal Potassium on Arrhythmia Risk During Pediatric Digoxin Therapy. Pediatr Cardiol 45, 901–908 (2024). https://doi.org/10.1007/s00246-022-03051-3

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  • DOI: https://doi.org/10.1007/s00246-022-03051-3

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