Which drug is ineffective for acute ventricular rate control in patients with atrial fibrillation and heart failure?

The drug identified as ineffective for acute ventricular rate control in patients with atrial fibrillation and heart failure is digoxin. In such clinical scenarios, timely and effective rate control is crucial to alleviate symptoms and improve hemodynamics.

Digoxin has a slower onset of action compared to other agents, making it less effective for acute rate control. While digoxin can be beneficial in chronic situations or in patients with heart failure alongside atrial fibrillation due to its positive inotropic effects, it does not provide rapid rate control in an acute context. This is particularly true when compared to other options, such as amiodarone, diltiazem, and beta-blockers, which can achieve immediate control of ventricular response rates.

Amiodarone can provide both rate and rhythm control for atrial fibrillation, particularly in patients with heart failure. Diltiazem, a calcium channel blocker, is often used for real-time control of heart rates in atrial fibrillation. Beta-blockers also contribute to lowering heart rates effectively during acute episodes. Thus, while digoxin has its place in the management of atrial fibrillation and heart failure, it is not the preferred agent for immediate rate control during acute episodes.