Harvard Heart Letter

Digoxin useful … with restrictions

Low doses for rhythm control may be safe, doctors say.

Digoxin is a medication often used to treat atrial fibrillation, one of the most common heart rhythm disturbances. This disorder causes the heart to beat rapidly and irregularly. Digoxin lowers the heart rate and helps bring it under control.

Although digoxin has been used by millions of people over the years, doctors have been concerned about its safety for decades. The safety issue arose again after the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial results were published in the Nov. 27, 2012, European Heart Journal. This trial concluded that digoxin increased the risk of death. Dr. Peter Zimetbaum, a heart rhythm specialist at Harvard-affiliated Beth Israel Deaconess Medical Center, says that this trial reaffirms the need for caution when using digoxin, but does not change his practice. "There is simply no good alternative to it for some people," he says. "Digoxin should be used carefully and in as low a dose as possible."

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