Treatment of Cardiac Glycoside Toxicity with Digoxin-Associated Bradyarrhythmia or Atrioventricular Block

Digoxin toxicity can produce significant cardiac rhythm disturbances. When the presenting picture is bradyarrhythmia or atrioventricular (AV) block, the treatment decision diverges from standard arrhythmia management and follows a specific evidence-based pathway.

Clinical Scenario

This protocol applies to cardiac glycoside toxicity presenting as digoxin-associated bradyarrhythmia — specifically cardiac bradycardia and atrioventricular block. Heart rhythm abnormalities including bradycardia/AV block, as well as certain tachyarrhythmias such as paroxysmal atrial tachycardia with block, are recognised manifestations of digoxin toxicity.

Treatment Direction

The evidence-based approach for this presentation is antidotal, centred on a specific antibody-based therapy (digoxin immune Fab), and is preferred over mechanical rhythm support such as temporary transvenous pacing. The full protocol details the criteria and management steps involved.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.amjmed.2024.08.018

Digoxin-associated bradyarrhythmia should be treated antidotally rather than with a temporary transvenous pacemaker.
Heart rhythm abnormalities, including bradycardia/atrioventricular block and some tachyarrhythmias (eg, paroxysmal atrial tachycardia [PAT] with block) are associated with digoxin toxicity.

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