Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo.
OBJECTIVE
A randomized, double-blind study with a high dose of digoxin administered intravenously for conversion of atrial fibrillation (not due to haemodynamic alternations) to sinus rhythm, and for rate control in converters and non-converters was set up. Outcome measures were conversion within 12 h; time to conversion; early rate control; and stable slowing within 12 h.


METHODS
We studied 40 patients with recent onset (< 1 week) atrial fibrillation; controls received saline intravenously, the other patients digoxin 1.25 mg.


RESULTS
One patient converted before digoxin administration. Conversion occurred in 9/19 patients on digoxin and in 8/20 on placebo (ns). The mean time to conversion tended to be shorter only for digoxin. Two late conversions on placebo were observed within 24 h. Heart rate during atrial fibrillation decreased after 30 min for converters and non-converters (P < 0.05). For all patients on digoxin, heart rate after 30 min was lower compared to baseline (P < 0.002) and to placebo (P < 0.02). Persistent, stable slowing occurred only in 3/10 non-converters on digoxin (P < 0.05), and two patients developed bradyarrhythmias. QTc was shortened immediately after conversion in all patients. Converters had baseline characteristics similar to those of non-converters.


CONCLUSIONS
Intravenous digoxin offers no substantial advantages over placebo in recent onset atrial fibrillation with respect to conversion, and provides weak rate control.
Jordaens
L
L
Department of Cardiology, University Hospital, Ghent, Belgium.
Trouerbach
J
J
Calle
P
P
Tavernier
R
R
Derycke
E
E
Vertongen
P
P
Bergez
B
B
Vandekerckhove
Y
Y
D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D004077:Digoxin / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged
D000889:Anti-Arrhythmia Agents; D004077:Digoxin