Intravenous digoxin in acute atrial fibrillation. Results of a randomized, placebo-controlled multicentre trial in 239 patients. The Digitalis in Acute Atrial Fibrillation (DAAF) Trial Group

Abstract

Aims: The DAAF Trial was designed to investigate whether digoxin, within 16 h of its use, increases the rate of conversion to sinus rhythm in patients with acute atrial fibrillation.

Methods and results: In a randomized, double-blind multicentre trial the effects of intravenous digoxin and placebo, (mean dose 0.88 +/- 0.35 mg and 0.96 +/- 0.37 mg) were compared in 239 patients with a mean age of 66.2 +/- 13.0 years and atrial fibrillation of, at most, 7 days' duration. The mean arrhythmia duration was 21.7 +/- 30.4 h and baseline heart rate 122.0 +/- 23.0 beats.min-1. At 16 h, 46% of the placebo group and 51% of the digoxin group had converted to sinus rhythm, (ns). Time to sinus rhythm was shorter in the digoxin group, but the difference was not significant. Digoxin had a pronounced and rapid effect on heart rate, which was already significant at 2 h; 104.6 +/- 20.9 beats.min-1 vs 116.8 +/- 22.5 beats.min-1 (P = 0.0001).

Conclusion: Acute intravenous treatment with digoxin does not increase the rate of conversion to sinus rhythm, but has a fast acting and clinically significant effect on heart rate and should remain an alternative in haemodynamically stable patients.