Refer kDT 7/e p516.. Medical useEdit Irregular heabeatEdit The most common indications for digoxin are atrial fibrillation and atrial flutter with rapid ventricular response, though beta blockers and/or calcium channel blockers are often preferred. There is tentative evidence that digoxin may increase the risk of death, though another meta-analysis in 2015 repoed no change in moality. Hea failureEdit Digoxin is no longer the first choice for hea failure; it has fallen out of or in people with hea failure because it may increase the risk of death. Currently, the recommendation for hea failure is a triple therapy of ACE inhibitor, beta blocker and mineralocoicoid antagonists. Digoxin is a third-line therapy. AboionEdit Digoxin is also used intrafetally or amniotically during aboions in the late second trimester and third trimester of pregnancy. It typically causes fetal demise(measured by cessation of cardiac activity) within hours of administration. Side effectsEdit Main aicle: List of side effects of digoxin Fuher information: Digoxin toxicity The occurrence of adverse drug reactions is common, owing to its narrow therapeutic index (the margin between effectiveness and toxicity). Gynaecomastia (enlargement of breast tissue) is mentioned in many textbooks as a side effect, thought to be due to the estrogen-like steroid moiety of the digoxin molecule, but when systematically sought, the evidence for this is equivocal as of 2005. The combination of increased (atrial) arrhythmogenesis and inhibited atrioventricular (AV) conduction (for example paroxysmal atrial tachycardia with AV block - so-called "PAT with block") is said to be pathognomonic(that is, diagnostic) of digoxin toxicity.