An editorial notes that digoxin has not been the first choice for rate control in AF patients for some time, because of the availability of safer and more effective drugs. It is now widely recognised that it exerts its rate-controlling effects via enhancement of vagal tone, a mechanism that is easily overcome by exercise and other high catecholamine states. Safety continues to be an issue, with more patients hospitalised for adverse effects from digoxin than for any cardiovascular medicine other than antiplatelet and anticoagulant drugs. The main implication of this study and related data is that digoxin should be used selectively and with care in AF patients. The observational nature of the current study does not allow a decision to be made on whether use of digoxin for rate control in AF should be abandoned altogether? For now, there are still clinical circumstances (HF, difficult rate control, low blood pressure) where digoxin remains useful.