Does digoxin lower heart rate
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The Effect of Digoxin on Heart Rate: A Comprehensive Analysis
Introduction to Digoxin and Heart Rate Control
Digoxin is a cardiac glycoside commonly used in the management of various heart conditions, including atrial fibrillation (AF) and heart failure. One of its primary therapeutic effects is the reduction of heart rate. This article synthesizes findings from multiple studies to evaluate the efficacy of digoxin in lowering heart rate.
Digoxin in Acute Atrial Fibrillation and Flutter
Comparative Efficacy with Diltiazem
In a study comparing intravenous (i.v.) digoxin and i.v. diltiazem for the emergency treatment of acute atrial fibrillation and flutter (AFF), it was found that digoxin significantly reduced heart rate, but the effect was slower compared to diltiazem. Diltiazem decreased heart rate within 5 minutes, while digoxin took up to 180 minutes to achieve a statistically significant reduction . This suggests that while digoxin is effective, it may not be the best choice for rapid heart rate control in acute settings.
Placebo-Controlled Studies
A randomized, double-blind study comparing high-dose i.v. digoxin to placebo in patients with recent-onset AF showed that digoxin reduced heart rate significantly within 30 minutes for both converters and non-converters to sinus rhythm . However, the overall rate control was weak, indicating that while digoxin can lower heart rate, its efficacy may be limited in some clinical scenarios.
Chronic Atrial Fibrillation and Heart Rate Control
Combination Therapy with Diltiazem
In patients with chronic AF, medium-dose diltiazem combined with digoxin was found to be more effective in controlling heart rate both at rest and during exercise compared to digoxin alone . This combination therapy enhanced the heart rate-lowering effects of digoxin, suggesting a synergistic benefit when used together.
Long-Term Outcomes in Heart Failure
In older patients with heart failure and preserved ejection fraction (HFpEF), digoxin treatment was associated with increased mortality and re-admission rates, particularly in those with lower heart rates . This highlights the need for careful consideration of heart rate when prescribing digoxin in this population.
Digoxin Withdrawal and Heart Rate
Impact on Exercise Capacity and Heart Rate
The PROVED trial demonstrated that withdrawal of digoxin in patients with chronic heart failure led to worsened exercise capacity and increased heart rate, reinforcing the drug's role in maintaining lower heart rates and improving functional status in these patients .
Systolic Function Improvement
The RATE-AF trial showed that digoxin improved systolic cardiac function in patients with permanent AF and HFpEF, with significant improvements in left ventricular ejection fraction and other systolic parameters compared to beta-blockers . This suggests that digoxin not only lowers heart rate but also enhances cardiac function in specific patient groups.
Comparative Studies with Other Medications
Digoxin vs. Calcium Channel Blockers and Beta-Blockers
Studies comparing digoxin with other medications like verapamil and metoprolol have shown mixed results. While digoxin effectively reduces heart rate, it is often less effective than beta-blockers and calcium channel blockers in acute settings . However, in chronic management, digoxin combined with other medications can provide better heart rate control and improve exercise tolerance .
Conclusion
Digoxin is effective in lowering heart rate in various clinical scenarios, particularly in chronic atrial fibrillation and heart failure. However, its slower onset of action in acute settings and potential adverse outcomes in certain populations necessitate careful patient selection and consideration of combination therapies. Further research is needed to fully understand the long-term effects and optimal use of digoxin in heart rate management.
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