Impact of digoxin on sinus rhythm restoration after catheter ablation of persistent atrial fibrillation and drug-refractory atrial tachyarrhythmia recurrence: A cohort study

ObjectiveEarly rhythm control has demonstrated clinical benefits even among patients with persistent atrial fibrillation. However, some patients continue to experience recurrent atrial tachyarrhythmias despite undergoing catheter ablation and treatment with antiarrhythmic drugs. This study aimed to assess the efficacy of digoxin in restoring sinus rhythm among patients with recurrent atrial tachyarrhythmias after catheter ablation and ongoing medical therapy.MethodsBetween 1 January 2013 and 1 September 2023, a total of 194 patients underwent catheter ablation for persistent atrial fibrillation. Among these, 96 (49.5%) patients experienced recurrence of atrial tachyarrhythmia during follow-up after catheter ablation. Of these, 12 patients with sustained arrhythmias despite at least 1 month of treatment with antiarrhythmic drugs and rate-control medications were treated with digoxin. Patients who achieved sinus rhythm after digoxin administration were categorized as the digoxin-effective group, and those who did not were classified as the non-digoxin-effective group. Clinical characteristics, medications, and echocardiographic parameters were compared between the two groups.ResultsAmong the 12 patients analyzed (mean age: 66 ± 7 years; 3 males and 9 females), 7 (58.3%) achieved sinus rhythm after digoxin administration. Patients in the digoxin-effective group exhibited significantly smaller left atrial sizes than those in the non-digoxin-effective group (39.2 ± 3.3 mm vs. 46.8 ± 2.6 mm, p = 0.017). Most recurrences in the digoxin-effective group were atrial tachycardia episodes (5/7, 71.4%). The median duration from digoxin initiation to sinus rhythm restoration was 49 days (range: 21-210 days). No serious adverse effects occurred.ConclusionsDigoxin effectively restored sinus rhythm in selected patients experiencing recurrent atrial tachyarrhythmias after catheter ablation and ongoing medical therapy, particularly among those with smaller left atrial sizes. Further research is warranted to validate these findings and explore the underlying mechanisms.