Digoxin heart rate
Pro Research Analysisby 
Searched over 200M research papers
Digoxin and Heart Rate Control in Atrial Fibrillation
Introduction to Digoxin and Atrial Fibrillation
Atrial fibrillation (AF) is a common cardiac arrhythmia characterized by an irregular and often rapid heart rate. Digoxin, a cardiac glycoside, is frequently used to manage heart rate in patients with AF. This article synthesizes research findings on the efficacy of digoxin in controlling heart rate in AF patients.
Digoxin vs. Placebo for Heart Rate Control
Several studies have compared the effects of digoxin to placebo in patients with AF. A randomized, double-blind study found that intravenous digoxin did not significantly increase the rate of conversion to sinus rhythm compared to placebo but did result in a significant reduction in heart rate within 30 minutes . Another multicenter trial confirmed that while digoxin did not significantly increase the conversion rate to sinus rhythm, it had a rapid and pronounced effect on heart rate reduction .
Digoxin vs. Other Medications
Digoxin vs. Diltiazem
In emergency settings, intravenous diltiazem has been shown to be more effective than digoxin for rapid ventricular rate control in acute AF. Diltiazem significantly reduced heart rate within 5 minutes, whereas digoxin took up to 180 minutes to achieve a similar effect . Additionally, a study comparing medium- and high-dose diltiazem with digoxin found that diltiazem was superior in controlling heart rate during exercise .
Digoxin vs. Beta-Blockers
The RATE-AF trial compared digoxin with beta-blockers in patients with permanent AF and heart failure. The study found that digoxin improved systolic function and had fewer adverse events compared to beta-blockers . Another trial comparing digoxin with bisoprolol found no significant difference in quality of life at 6 months, but digoxin was associated with fewer adverse events .
Digoxin vs. Verapamil and Metoprolol
In patients with mitral stenosis and AF, digoxin was less effective in improving exercise capacity compared to verapamil and metoprolol. Verapamil and metoprolol provided better subjective improvement and greater total work done during exercise .
Combination Therapy
Combining digoxin with other medications can enhance its efficacy. For instance, combining digoxin with diltiazem resulted in better heart rate control both at rest and during exercise compared to digoxin alone . Similarly, adding nadolol to digoxin therapy significantly reduced both resting and exercise-induced heart rates in patients with chronic AF .
Long-Term Efficacy and Safety
A systematic review and meta-analysis of randomized clinical trials indicated that while digoxin is effective in reducing heart rate compared to placebo, it is inferior to beta-blockers and calcium antagonists for acute heart rate control. The long-term effects of digoxin on all-cause mortality, serious adverse events, and quality of life remain unclear due to the lack of long-term follow-up in the studies reviewed .
Conclusion
Digoxin is effective in reducing heart rate in patients with AF, particularly when combined with other medications. However, it is generally less effective than diltiazem and beta-blockers for rapid rate control. The choice of therapy should be individualized based on patient characteristics, the urgency of rate control, and potential adverse effects. Further research is needed to clarify the long-term benefits and risks of digoxin in AF management.
Sources and full results
Most relevant research papers on this topic