PII: S0196-0644(01)70100-X

Abstract

We thank Dr. Veloso for his interest in our study but would certainly disagree with his contention that the available evidence shows the efficacy of digoxin over placebo in converting very recent (<24 hours’ duration) atrial fibrillation (AF) to sinus rhythm. He correctly states that there have been 4 published trials 1 Falk RH Knowlton AA Bernard AS et al. Digoxin for converting atrial fibrillation to sinus rhythm. A randomized, double-blinded trial.. Ann Intern Med. 1987; 106: 503-506 Crossref PubMed Scopus (292) Google Scholar , 2 Jordaens L Trouerbach J Calle P et al. Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo. Eur Heart J. 1997; 18: 643-648 Crossref PubMed Scopus (115) Google Scholar , 3 The Digitalis in Acute Atrial Fibrillation DAAF Trial Group Intravenous digoxin in acute atrial fibrillation. Results of a randomized, placebo-controlled multicentre trial in 239 patients.. Eur Heart J. 1997; 18: 649-654 Crossref PubMed Scopus (152) Google Scholar , 4 Bianconi L Mennuni M for the PAFIT-3 Investigators Comparison between propafenone and digoxin administered intravenously to patients with acute atrial fibrillation. Am J Cardiol. 1998; 82: 584-588 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar that compared digoxin and placebo for reversion to sinus rhythm, and none of these have shown any statistical difference. Dr. Veloso contends that the lack of difference was because of the longer duration of AF in the above studies, but this argument does not carry weight on closer scrutiny. The DAAF Trial, 3 The Digitalis in Acute Atrial Fibrillation DAAF Trial Group Intravenous digoxin in acute atrial fibrillation. Results of a randomized, placebo-controlled multicentre trial in 239 patients.. Eur Heart J. 1997; 18: 649-654 Crossref PubMed Scopus (152) Google Scholar which was the largest of these studies (239 patients), had mean and median durations of arrhythmia of 21.7 and 10.3 hours, respectively (ie, the vast majority had AF durations of <24 hours). This study found reversion rates at 16 hours with digoxin (51%), which is very similar to rates found with placebo (46%), and the difference was not statistically significant (P =.37). We note the similarity with the results of our study, 5 Joseph AP Ward MR. A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. Ann Emerg Med. 2000; 36: 1-9 Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar which showed reversion rates of 50% at 24 hours and 58% at 48 hours for digoxin.