Dronedarone: Current evidence for its safety and efficacy in the management of atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia. Management of AF ncludes rate control, rhythm control if necessary, prevention of thromboembolic events,and reatment of the underlying disease. Rate control is usually achieved by pharmacological suppression of calcium currents or by applying?-blockers or digitalis compounds. In contrast, the number of compounds available for rhythm control is still limited. Class Ic agents ncrease mortality in patients with structural heart disease, and amiodarone harbors an extensive side veffect profile despite its efficacy in maintaining sinus rhythm. Furthermore, rhythm control by these compounds has not been shown to reduce patient mortality. Dronedarone is a new ntiarrhythmic drug that has been developed to provide rhythm and rate control in AF patients with fewer side effects compared with amiodarone. This review primarily focuses on clinical trials evaluating efficacy and safety of the novel drug. Conclusions from these studies are ritically reviewed, and recommendations for clinical practice are discussed. Dronedarone ignificantly reduced the incidence of hospitalization due to cardiovascular events or death in igh-risk patients with atrial fibrillation (ATHENA trial). However, dronedarone was less fficient than amiodarone in maintaining normal sinus rhythm (DIONYSOS trial) and is ontraindicated in severe or deteriorating heart failure (ANDROMEDA trial). In summary, ronedarone represents a valuable addition to the limited spectrum of antiarrhythmic drugs and s currently recommended in patients with paroxysmal and persistent AF to achieve rate and hythm control, excluding cases of severe or unstable congestive heart failure. © 2011 chweizer et al, publisher and licensee Dove Medical Press Ltd.