Combined use of esmolol and digoxin in the acute treatment of atrial fibrillation or flutter.

Safety and efficacy of simultaneous use of intravenous digoxin and esmolol in the control of rapid heart rate in 21 patients with atrial fibrillation or flutter was assessed. The mean age was 67 (range 40 to 90) years. Seven patients had class III congestive heart failure, with left ventricular ejection fraction between 18% and 61%. Baseline mean heart rate was 143 +/- 4. After 0.25 mg or 0.5 mg intravenous digoxin, esmolol was titrated with initial boluses from 2 mg/min to 16 mg/min in 25 minutes. A tolerated dose of esmolol infusion was adjusted for up to 48 hours. Rapid control of heart rate (29% decrease with heart rate 101 +/- 4) occurred at a mean interval of 21 minutes. Minimum heart rate was 87 +/- 4 at 90 minutes of treatment. Conversion to sinus rhythm occurred in five patients (25%), and one patient experienced mild transient congestive heart failure. No symptomatic hypotension or bronchospasm occurred. In conclusion, simultaneous use of digoxin and esmolol is effective in safely and rapidly controlling heart rate in atrial fibrillation or flutter.