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While no doubt has ever been cast on the usefulness of digitalis in cardiac failure with atrial fibrillation and a fast ventricular rate, they are periodically brought into question regarding chronic cardiac failure in sinus rhythm. While they have not been supplanted by new positive inotropic agents, they are in competition with converting enzyme inhibitors. Recent therapeutic trials have shown that digitalis preparations, alone or in association with converting enzyme inhibitors, have beneficial effects on symptoms and exercise duration in patients with symptomatic impaired left ventricular systolic function. While the effects of digitalis preparations on mortality remain unknown, a large North American study should soon provide an answer to this question.
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