Role of digoxin in controlling the ventricular rate during atrial fibrillation: a systematic review and a rethinking

Although digitalis has been used since the last century, it seems to be in the process of being progressively abandoned. However, digoxin has demonstrated a large positive benefit in terms of reduction of morbidity in heart failure patients with sinus rhythm, while the sometimes-observed increase in mortality is dramatically reduced with low serum concentrations. Digoxin, which is the only digitalis currently available, remains one of three drugs used for rate control in atrial fibrillation. Even if digoxin alone is insufficient to provide rate control during exertion in most patients, the optimal cardiac rate both at rest and at exertion is still undetermined, as is the importance of achieving sufficient rate control in asymptomatic patients. Because of its low cost and the accumulated knowledge and expertise about prescription, digoxin probably will remain an undisputed medication for rate control for atrial fibrillation, especially for heart failure patients.