[Should chronic atrial fibrillation be treated with digoxin?]

Abstract

For decades, atrial fibrillation was treated exclusively with digoxin. The introduction of Ca-antagonists and beta-blockers has, however, produced valuable alternatives as ventricular function can now be controlled both at rest and during exercise whereas, with digoxin, ventricular function could only be controlled at rest. This review deals with the etiology and electrophysiology of atrial fibrillation together with the effects of Ca-antagonists and beta-blockers on conduction and control of the heart rate during exercise. Documentation of the effects of the different drugs, separately and combined, in the treatment of atrial fibrillation during rest and exercise is presented. It is concluded that alteration in the therapeutic strategy appears reasonable in favour of a combination of digoxin and also Ca-antagonists/beta-blocker.