Dig in A.fib

 Q:  Although less in use but digoxin is more effective than beta-blockers (BBs) and calcium channel blockers (CCBs) in terminating atrial fibrillation (AF).

A) True

B) False

Answer: B

The answer is false (choice B). Neither it is more effective than BBs and CCBs nor does it has any ability to terminate AF. In ICUs digoxin should not be used as a first-line drug for rate control during Rapid Ventricular Rate (RVR), though it can be used in case of no response to BBs and/or CCBs - or as an adjuvant treatment. Moreover, it has no immediate effect. It has to bind with protein to act, which takes about 2-3 hours.

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References:

1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130:2071. 

2. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130:e199.

3. Shettigar UR, Toole JG, Appunn DO. Combined use of esmolol and digoxin in the acute treatment of atrial fibrillation or flutter. Am Heart J 1993; 126:368.