Digoxin in Right Ventricular Dysfunction

Evidence and Recommendations

The American College of Cardiology recommends that digoxin should not be used to treat isolated right ventricular dysfunction, as it provides no benefit in RV-specific outcomes 1
In patients with biventricular failure and left ventricular ejection fraction (LVEF) <40%, the American Heart Association suggests adding digoxin to reduce heart failure hospitalizations, with a target serum digoxin concentration of 0.5-0.9 ng/mL 1, 2
For patients with right ventricular dysfunction and atrial fibrillation with inadequate rate control, the American College of Cardiology recommends using digoxin as an adjunct to beta-blockers for rate control, with beta-blockers remaining first-line 1, 3
The American Heart Association advises against using digoxin in patients with absolute contraindications, including second- or third-degree heart block without permanent pacemaker, pre-excitation syndromes, and previous digoxin intolerance 1, 2, 3
Mandatory monitoring is required, including serial serum potassium and magnesium, renal function, and target therapeutic level of 0.5-0.9 ng/mL 1, 2, 3
Drug interactions requiring dose reduction by 50% include amiodarone, diltiazem, verapamil, certain antibiotics, and quinidine 1, 3
The American Thoracic Society recommends treating the underlying cause of right ventricular dysfunction, using diuretics for volume management, oxygen therapy if hypoxemic, and pulmonary vasodilators if pulmonary hypertension is present 2

The American College of Chest Physicians suggests focusing on treating the underlying cause of right ventricular dysfunction, rather than using digoxin, with a strength of evidence rated as high 2
Beta-blockers are recommended for concurrent atrial fibrillation requiring rate control, with a strength of evidence rated as moderate 3