Atrial fibrillation: acute: no clear benefit from digoxin.

Clinical bottom line (level 1b-)

  1. Patients with recent-onset atrial fibrillation who had iv digoxin compared with placebo were not clearly more likely to revert to sinus rhythm or have a stable lower heart rate at 24 hours.
Jordaens et al: European Heart Journal 1997; 18: 643-648
Expires November 2003

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: two acute hospitals, Belgium

40 patients (aged mean 64 years, 58% male) recent onset atrial fibrillation (< 1 week) with ventricular rate >100 bpm

Excluded if
  • received cardiac glycosides within 1 week
  • antiarrhythmic within previous 72 hours
  • previous use of amiodarone
  • acute MI or recent CABG
  • haemodynamic or respiratory instability
  • electrolyte disturbances


    • Control Group: (n = 20, 20 analysed): placebo
    Experimental Group: (n = 20, 19 analysed): digoxin initially 0.75 mg iv then 0.25 mg after 4 and 8 hours.

    98% followed for 24 hours

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no conversion to sinus rhythm 12 hours 12
    (60.0%)    		 10
    (52.6%)    		 12%
    (-53% to 50%)    		 7.37%
    (-23.7% to 38.4%)    		 14
    (NNT = 3 to infinity;
    NNH = 4 to infinity)
    persistent slowing of heart rate (<100 bpm) 24 hours 0
    (0.00%)    		 3
    (15.8%)    		 %
    (% to %)    		 -15.8%
    (-32.2% to 0.61%)    		 -6
    (NNT = 170 to infinity;
    NNH = 3 to infinity)

  • Heart rate had slowed within one hour in patients given digoxin - however there was no difference in rate compared with patients given placebo.

    • Comments

    1. The study is not large enough to show any clear differences between the two groups.

    Citation

    1. Jordaens L, Trouerbach J, Calle P, et al: Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison with placebo. European Heart Journal 1997; 18: 643-648
    Search Terms: atrial fibrill* in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient AF
    Intervention or Exposure digoxin
    Comparison placebo
    Outcome sinus rhythm