Digoxin Toxicity in a Patient with Pacemaker: A Case Report

Digoxin is a cardiac myocyte sodium/potassium ATPase inhibitor with a narrow therapeutic index used to treat patients with conditions such as heart failure with reduced ejection fraction and atrial fibrillation. Currently, digoxin-specific antibody fragments serve as a therapeutic option in patients with digoxin toxicity; however, the indications for digoxin-specific antibody fragments are inconsistent, and some sources report a serum digoxin concentration of >12 ng/mL as a treatment indication. We discuss a case of an asymptomatic elevated digoxin level of 13.5 ng/mL secondary to a dosing error, who was managed without digoxin-specific antibody fragments as well as a brief retrospective chart review for patients with a pacemaker presenting with a high digoxin concentration managed with and without digoxin-specific antibody fragments, with equivocal findings.