Is maintenance digoxin necessary in patients with sinus rhythm?

Area of Science:

• Cardiology
• Pharmacology

Background:

• Digoxin is a long-standing cardiac glycoside used for heart failure and arrhythmias.
• Assessing the necessity of long-term digoxin therapy is crucial for patient management.

Purpose of the Study:

• To evaluate the feasibility and safety of discontinuing long-term digoxin therapy in patients with sinus rhythm.
• To identify predictors of successful digoxin withdrawal.

Main Methods:

• A cohort of 56 patients on long-term digoxin with sinus rhythm had their medication discontinued.
• Plasma-digoxin concentrations were measured before withdrawal.
• Clinical status and development of arrhythmias or heart failure were monitored post-discontinuation.

Main Results:

• 86% of patients (48/56) successfully discontinued digoxin without clinical deterioration.
• Patients with pre-withdrawal plasma-digoxin levels < 0.8 ng/ml had a high success rate (33/34).
• Deterioration, primarily new-onset atrial fibrillation, occurred in 7 of 22 patients with levels between 0.8-2.0 ng/ml.

Conclusions:

• Digoxin discontinuation is feasible in a majority of patients with sinus rhythm.
• Lower baseline plasma-digoxin concentrations are associated with successful withdrawal.
• Monitoring for atrial fibrillation is essential upon digoxin discontinuation.