INTRAVENOUS DIGOXIN IN ACUTE ATRIAL-FIBRILLATION - RESULTS OF A RANDOMIZED, PLACEBO-CONTROLLED MULTICENTER TRIAL IN 239 PATIENTS

Aims The DAAF Trial was designed to investigate whether digoxin, withi n 16 h of its use, increases the rate of conversion to sinus rhythm in patients with acute atrial fibrillation. Methods and results In a ran domized, double-blind multicentre trial the effects of intravenous dig oxin and placebo, (mean dose 0.88 +/- 0.35 mg and 0.96 +/- 0.37 mg) we re 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 arrhythmi a 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 digox in 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 al ready 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 wi th digoxin does not increase the rate of conversion to sinus rhythm, b ut has a fast acting and clinically significant effect on heart rate a nd should remain an alternative in haemodynamically stable patients.