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Digitalis has long been used as an antiarrhythmic drug in treatment of paroxysmal supraventricular tachycardia, atrial fibrillation and flutter, and arrhythmias associated with congestive heart failure. However, newer evidence indicates that this cardiac glycoside has limited potency as an antiarrhythmic drug. In this review, the authors describe the effect of digitalis on cardiovascular function in management of atrial fibrillation and flutter. They conclude that while widespread use of digitalis as initial treatment for these supraventricular arrhythmias is justified by its low cost, ease of administration, and relatively few noncardiac side effects, newer drugs may ultimately prove more useful.