[Digitalis and sinus rhythm. An old question that is still current].

To study the efficacy of chronic digitalis therapy in patients with congestive heart failure and sinus rhythm, a bibliographic search was fulfilled. 12 clinical trials were found and analyzed from a clinical and methodological point of view. These studies have shown a discrepancy between the clinical and haemodynamic efficacy of the drug. Usually patients' symptoms don't improve as it should be expected from the haemodynamic data. It is possible and advisable to withdraw a chronic treatment in many stable patients without worsening the clinical conditions. However some methodological bias (research strategies, patient selections, follow-up analysis and clinical and haemodynamic criteria) seem to reduce the results' reliability. The old question of digitalis efficacy in sinus rhythm is still controversial: new inotropic drugs are appearing. The lesson from the digitalis controversy should be seriously considered in the clinical evaluation of these new therapeutic agents.