Does digoxin have a place in the treatment of the child with congenital heart disease?

Abstract

The place of digoxin in the pediatric cardiologist's armamentarium remains uncertain. As an antiarrhythmic, its use in the Wolff-Parkinson-White syndrome is obsolete, but it remains useful in the treatment of the chronic atrial fibrillation seen in some patients postoperatively and in children with dilated cardiomyopathy. The efficacy of digoxin in heart failure is unproven. There is some evidence of improvement in non invasive left ventricular contractile indices in neonates and infants, but it is unclear whether this is associated with sustained clinical improvement. There is even less evidence of its effectiveness in the older child. Whilst the measurement of any effect will undoubtedly be difficult, the time has come for double-blind, placebo-controlled trials in selected groups of patients. These should be designed not only to test the notion that digoxin does not improve ventricular function, but also to embrace the possibility that its administration may result in clinical improvement over and above that following diuretics alone. An absence of proof of efficacy must be distinguished from no efficacy--more data are needed.

Association of Digoxin With Interstage Mortality: Results From the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Use Dataset

“…Indeed, digoxin, the oldest drug available for treatment of HF, was formerly the mainstay of treatment for HF in both adults and children given its supposed effects on inotropy, chronotropy, and the sympathetic nervous system, although its demonstration in laboratory studies did not always translate to clinical improvement. [19][20][21][22][23] However, in 1997, the Digitalis Investigation Group conducted a randomized, placebo-controlled trial of 7800 adults and found no improvement in mortality. 24 Digoxin use subsequently declined both among adults and children.…”

Perioperative mortality is the Achilles heel for cardiac transplantation in adults with congenital heart disease: Evidence from analysis of the UNOS registry

“…The management of ACHDR poses unique challenges due to the complex anatomy and physiology frequently encountered in this population. ACHDR with a systemic right ventricle respond differently to the usual heart failure medication which may result in suboptimal medical treatment . ACHDR are more likely to be younger, female, and less likely to be supported with a ventricular assist device (VAD).…”