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9 of patients in the placebo arm were suspected of having digoxin toxicity, the most common symptoms being new episodes of ventricular fibrillation, supraventricular arrhythmia, tachycardia, or advanced atrioventricular block.

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digoxin is known to slow heart rates and potentiate bradyarrhythmias 25 through its parasympathetic effect on the av node, but has little effect on fast ventricular rates in the setting of enhanced sympathetic tone.

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it may be desirable to reduce the dose of or discontinue lanoxin for 1-2 days prior to electrical cardioversion of atrial fibrillation to avoid the induction of ventricular arrhythmias, but physicians must consider the consequences of increasing the ventricular response if digoxin is decreased or withdrawn.

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