Digoxin for atrial fibrillation: a drug whose time has gone?

Area of Science:

• Cardiology
• Pharmacology

Background:

• Digitalis compounds, including digoxin, have a 200-year history in treating atrial fibrillation.
• Digoxin is commonly used for rate control in rapid ventricular response and has been proposed for other indications like terminating atrial fibrillation and prophylaxis.

Purpose of the Study:

• To review the current role of digoxin in managing chronic, recent-onset, and paroxysmal atrial fibrillation.
• To evaluate the scientific evidence supporting digoxin's efficacy in various atrial fibrillation scenarios.

Main Methods:

• Review of recent scientific studies on digoxin's use in atrial fibrillation.
• Analysis of digoxin's effectiveness in heart rate control, arrhythmia termination, and prophylaxis.

Main Results:

• Digoxin is a poor choice for heart rate control during exertion in atrial fibrillation patients.
• Evidence suggests digoxin has minimal to no effect on terminating atrial fibrillation.
• Digoxin may exacerbate paroxysmal atrial fibrillation, with no difference in heart rate at onset compared to controls.

Conclusions:

• The traditional uses of digoxin in atrial fibrillation require re-evaluation based on current scientific evidence.
• Digoxin's role in managing atrial fibrillation, particularly during exertion and for paroxysmal forms, is limited and potentially detrimental.