Digoxin Toxicity

ECG Features of Digoxin Toxicity

The classic digoxin toxic dysrhythmia combines:

Other common dysrhythmias associated with digoxin toxicity include:


Digoxin can cause a multitude of dysrhythmias due to:

  • Increased automaticity (increased intracellular calcium)
  • Decreased AV conduction (increased vagal effects at the AV node)

Clinical features of Digoxin Toxicity
  • GIT: Nausea, vomiting, anorexia, diarrhoea
  • Visual: Blurred vision, yellow/green discolouration, haloes
  • CVS: Palpitations, syncope, dyspnoea
  • CNS: Confusion, dizziness, delirium, fatigue

ECG Examples
Example 1
Digoxin Toxicity Bigeminy 2


  • Sinus rhythm with frequent PVCs in a pattern of ventricular bigeminy

Example 2
Digoxin toxicity PAT with block PVC

Paroxysmal atrial tachycardia with block

  • Atrial tachycardia with high-grade AV block and PVCs

Example 3
Digoxin toxicity Regularised atrial fibrillation AF

Regularised AF

  • Coarse atrial fibrillation with 3rd degree AV block and a junctional escape rhythm.

Example 4
Regularised AF digoxin toxicity

Regularised AF

  • Another example of regularised AF.

Example 5
Digoxin Toxicity atrial tachycardia with block and frequent PVC

“Paroxysmal” atrial tachycardia with block and frequent PVCs

  • This is a classic ECG of digoxin toxicity showing atrial tachycardia (P waves at 150 bpm), high-grade 2nd degree AV block (A:V ratio of 4:1) with frequent premature ventricular complexes.

Example 6
Atrial flutter with block digoxin toxicity

Atrial flutter with AV block

  • Atrial flutter with a slow ventricular rate due to digoxin toxicity.

Example 7
ECG Bidirectional ventricular tachycardia

Bidirectional Ventricular Tachycardia (VT)

  • Example of Bidirectional VT.
  • There is a broad complex tachycardia with a frontal-plane axis that alternates by 180 degrees with each successive beat.

Advanced Reading



LITFL Further Reading


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner


  1. Thank you Ed and Robert for your hard work keeping all these pages up to date. It’s much appreciated.

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