ABSTRACT
Atrial fibrillation may be the cause of heart failure in a number of patients, i.e. the patients may present with all the symptoms and some of the signs of heart failure, but their LV systolic function may be relatively well maintained or even normal, and the primary abnormality is uncontrolled atrial fibrillation. In addition, up to 30% of patients with significant LV dysfunction have concomitant atrial fibrillation. Digoxin obviously has an important role to play in both these patient groups. In these instances, control of heart rate may result in significant symptomatic improvement. In addition, some patients with otherwise chronic stable heart failure may deteriorate because of the development of atrial fibrillation. If significant improvement is not obtained with rate control with the use of digoxin, these patients may be candidates for consideration for cardioversion. However, success rates may be low if there is an underlying cardiac structural abnormality, i.e. left ventricular and/or left atrial dilatation. The beneficial effects of digoxin in these groups of patients are primarily due to the electrophysiological effects of digoxin slowing atrioventricular (AV) nodal conduction.
