Tachycardia: delivery of digoxin had no clear effect on conversion to sinus rhythm.

Clinical bottom line (level 1b)

  1. Patients with atrial fibrillation who were given an infusion of digoxin, had no clear difference in conversion to sinus rhythm than those given bolus digoxin.
  2. Conversion to sinus rhythm in patients given an infusion of digoxin was quicker than conversion in those given a bolus.
  3. The median maximal serum digoxin level was greater in the bolus digoxin group.
Smit et al: European Journal of Clinical Pharmacology 1990; 38: 335-341
Expires October 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, The Netherlands

11 patients (aged mean 77 years, 55% male) atrial fibrillation with ventricular rate >120 beats/minute at entry

Excluded if
  • digitalisation not considered as the preferred treatment
  • use of antiarrhythmics or other drugs known to influence impulse formation or conduction during the study
  • serious electrolyte disturbances
  • recent myocardial infarction


    • Control Group: (n = 5, 5 analysed): bolus injections of digoxin given via three 2 ml ampoules injected at 8 hour intervals, over 60 seconds
    Experimental Group: (n = 6, 6 analysed): intravenous infusion of digoxin given as 250 ml glucose 5% by a volume-controlled infusion pump over 6 hours

    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    conversion to sinus rhythm unknown 2
    (40.0%)    		 5
    (83.3%)    		 -108%
    (-546% to 33.0%)    		 -43.3%
    (-95.6% to 8.95%)    		 2
    (NNT = 1 to infinity;
    NNH = 11 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    median maximal serum digoxin levels in µ g per litre 59.3
    ()     		6.85
    ()     		52.5
    ( to )

  • In the infusion group, conversion to sinus rhythm took a median of 323 minutes, and in the bolus group it occurred at 477 and 720 minutes.
  • The maximal fall in mean pulse rate was observed in the 8-9 hour period in the infusion group, and 19-20 hours in the bolus group.
  • Systolic blood pressure fell non-significantly after the bolus injections.
  • None of the patients developed signs of gastrointestinal toxicity during the study.

    • Citation

    1. Smit AJ, Scaf AHJ, van Essen LH, et al: Digoxin infusion versus bolus injection in rapid atrial fibrillation: relation between serum levels and response. European Journal of Clinical Pharmacology 1990; 38: 335-341
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient atrial fibrillation
    Intervention or Exposure digoxin infusion
    Comparison digoxin bolus injection
    Outcome serum levels