A case report of successful digoxin use for fast atrial fibrillation to facilitate emergency surgery in a bleeding patient

Atrial fibrillation complicated by a fast ventricular response rate can cause a significant physiological burden. This is characterised by systolic pump failure, decreased diastolic filling time and hypotension leading to impaired organ perfusion. Considering that most anaesthetic agents are cardiac suppressants, the additive effects of this condition together with anaesthesia may lead to increased perioperative morbidity and mortality. A 79-year-old male patient who presented with atrial fibrillation, caused by chronic obstructive pulmonary disease and pulmonary hypertension, and a fast ventricular response rate was booked for emergency ligation of the sphenopalatine artery for posterior epistaxis, complicated by significant blood loss. Both electrical and pharmacological alternatives exist to address this conundrum, but here we would like to present this case where digoxin was used successfully to rate control this patient perioperatively. Digoxin has recently fallen into disfavour for the chronic management of atrial fibrillation, and even in select cases of acute atrial fibrillation with a fast ventricular response rate, and the purpose of this case study is to highlight a potentially useful indication for this antiquated drug.