*6.2.4 Digoxin*

Digoxin and other cardiac glycosides have been long used to treat patients with heart failure and cardiac arrhythmias, atrial fibrillation among the latter. However, in the last couple of decades, various clinical trials have resulted in limiting the role of digoxin in the management of atrial fibrillation [52]. Digoxin acts at a cellular level by inhibiting the sodium-potassium pump, increasing the calcium availability to the contractile apparatus. This results in an increase in cardiac contractility and slowing of cardiac conduction through the atrioventricular node [69].

There is paucity of data regarding the use of digoxin in septic shock patients with NOAF. In a retrospective cohort study of ICU patients (n = 38,159) by Quian et al. [70], the investigators found an incidence of NOAF rounding 9%. After adjusting for multiple variables, they found that in patients with NOAF the use of digoxin was associated with an increased risk of 90-day mortality (hazard ratio 1.23, 95% CI 1.10–1.39, p < 0.001), although the proportion of sepsis patients in this population was not specified.
