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Aim: Recently, digoxin use has been found to associate with higher mortality. Yet, potential mechanisms by which digoxin use increases mortality remain unclear. Increased arrhythmogenicity from digoxin use is one possibility. Thus, we aimed to evaluate the relation between digoxin and shock events in patients with implantable cardioverter defibrillators (ICDs)., Methods: We performed a retrospective chart review of all patients with ICDs and at least 1 device interrogation at our institution between January 1, 2012, and January 1, 2015. We aimed to cover 1 year of interrogation period. Patients with heart failure, atrial fibrillation, or both were included in the analysis. Patients were divided into 2 groups based on digoxin use, defined as use of digoxin for any period of time during ICD interrogation period. Incidence of ICD shock events and electrical storms and hospitalizations were compared between the 2 groups., Results: The study included 202 patients. Of those, 55 patients were on digoxin and 147 were not on digoxin. Patients on digoxin were more likely to receive ICD shocks (odds ratio [OR] = 2.5, 95% confidence interval [95% CI] = 1.01-6.18, P = .04) and have increased risk of electrical storms ( P = .02). Moreover, total hospitalizations were higher in digoxin users ( P = .02). Multivariate logistic regression analysis also showed that digoxin use was an independent predictor of shock events (OR = 4.07, 95% CI = 1.43-11.58, P = .009)., Conclusion: Digoxin is associated with increased shock events and electrical storms in patients with ICDs; however, large randomized controlled studies are needed to confirm our findings.

Little attention has been directed towards investigating how senior managers and boards approach strategic decision-making when dealing with shock events as compared to strategic decision-making in a stable environment. This paper presents evidence to suggest that strategic decision-making following a shock event involves a more intuitive, less analytical and less consultative approach, while decision-making in a stable environment is characterised by a more cooperative, formal and analytical process. Decision-making following a shock event tends to be simplified and fast, whereas decision-making in a stable environment tends to be comprehensive and slow. Furthermore, the strategic role of the board transforms following a shock event from a limited involvement in strategy setting to a strong involvement in the setting of strategy. This research has important management implications signifying that crisis management must increasingly focus on building an organisation's ability to reach swift decisions in crisis situations and avoid analysis paralysis., (Copyright © 2006 Elsevier Ltd. All rights reserved.)