From the FDA Drug Label
It may be desirable to reduce the dose of digoxin for 1 to 2 days prior to electrical cardioversion of atrial fibrillation to avoid the induction of ventricular arrhythmias, but physicians must consider the consequences of increasing the ventricular response if digoxin is withdrawn
The required duration of digitoxin saturation before cardioversion is not explicitly stated, but for digoxin, it may be desirable to reduce the dose 1 to 2 days prior to electrical cardioversion. However, the question asks about digitoxin, not digoxin, and there is no information about digitoxin in the provided drug label. 1
From the Research
Required Duration of Digitoxin Saturation
- The required duration of digitoxin saturation before cardioversion is not explicitly stated in the provided studies.
- However, study 2 mentions that it is customary to withhold digoxin for 24 to 48 hours before cardioversion is attempted, but this is likely only necessary for patients who are close to or actually manifesting signs of drug toxicity.
- Study 3 found that patients with therapeutic serum levels of digoxin may safely undergo cardioversion without the concomitant use of class I antiarrhythmic agents, but it does not specify the required duration of digitoxin saturation.
Cardioversion and Anticoagulation
- Studies 4, 5, and 6 discuss the importance of anticoagulation before cardioversion to prevent thromboembolic events, but they do not provide information on the required duration of digitoxin saturation.
- These studies focus on the use of oral anticoagulants, such as warfarin and novel oral anticoagulants (NOACs), and their safety and efficacy in preventing thromboembolic events during cardioversion.
Digitoxin and Cardioversion
- Study 2 mentions that treatment with therapeutic concentrations of antiarrhythmic drugs, including digoxin, before cardioversion may be associated with a significant reduction in the number of shocks and decreased energy required to restore sinus rhythm.
- However, it does not provide specific information on the required duration of digitoxin saturation before cardioversion.