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The foxglove (Digitalis purpurea) is a common plant in the Midlands of England, where as I child I would enjoy the angry buzzing of bees that I trapped inside the flowers, until one stung me. An account of the Foxglove and some of its Medical Uses (1785) by the Reverend William Withering of Birmingham is often cited as the text that began modern pharmacology. It certainly began the pharmacological treatment of atrial fibrillation (AF), assuming that this is what Withering meant by “a tumultuous action of the heart,” which then as now was steadied by the right dose of foxglove. This remained the standard treatment for AF for the next 200 years, and even now we are searching for the best alternative to digoxin. The latest candidate rejoices in the name of vernakalant, which, given by infusion in a Canadian trial (Circulation 2008;117:1518–25), resulted in conversion to sinus rhythm in more than half of patients with AF arising in the previous week but fewer of those with longer term AF. A systematic review in …
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