Is dronedarone effective for the prevention of recurrent atrial fibrillation?

C Michael White

This article has no abstract so we have provided the first paragraph of the full text.

Dronedarone has a similar mechanism of action to amiodarone and held promise to be comparably efficacious, but without the associated toxicity. Clinical trial results on dronedarone were, however, lackluster until the publication of EURIDIS and ADONIS. An earlier study, DAFNE,¹ demonstrated an increase in the time to AF recurrence with dronedarone 800 mg/day, but no additional improvement above this dose. Furthermore, in DAFNE only 35% of patients receiving dronedarone maintained sinus rhythm at 6 months follow-up, compared with 10% of patients in the placebo group.¹ This finding contrasts poorly with those from previous placebo-controlled studies of amiodarone and sotalol, in which much higher percentages of patients maintained sinus rhythm (>50% for both).² ANDROMEDA³ evaluated the effect of dronedarone, in comparison with placebo, in high-risk patients with HF (ejection fraction <35%). Unfortunately, this study was stopped early due to higher overall mortality in the dronedarone group. The ERATO trial⁴ showed a dronedarone-induced reduction in ventricular response to AF compared with placebo, both at rest and with exercise, indicating that dronedarone was a reasonable adjunct to therapy with drugs that have negative dromotropic effects, such as -blockers and nondihydropyridine calcium channel blockers. Digoxin is a commonly used adjunctive agent with negative dromotropic effects, but does not reduce heart rate during exercise by any considerable extent.² For an antiarrhythmic drug to be relegated for ventricular rate control alone would, however, have been unusual.

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