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VIEWPOINT AND COMMENTARY

Dronedarone for Atrial Fibrillation

Have We Expanded the Antiarrhythmic Armamentarium?

Division of Cardiology, Cedars-Sinai Medical Center, and the David Geffen School of Medicine, University of California, Los Angeles, California

Manuscript received August 13, 2009; revised manuscript received September 29, 2009, accepted October 5, 2009.

^_* Reprint requests and correspondence: Dr. Sanjay Kaul, Division of Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048 (Email: kaul{at}cshs.rg).

Dronedarone is a new antiarrhythmic agent that was recently approved for the prevention of cardiovascular hospitalization driven by atrial fibrillation/flutter. Its approval was based largely on the results of the ATHENA (A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter) trial, which demonstrated a significant 24% reduction in the combined end point of all-cause mortality and cardiovascular hospitalization, primarily driven by the latter. However, several other clinical trials have evaluated the impact of dronedarone on various cardiovascular end points and yielded mixed results. In this article, we summarize the available evidence concerning dronedarone, and offer practical recommendations to health care providers regarding its use in the treatment of atrial fibrillation. We conclude that the available data support the use of dronedarone in select patient populations as a second- or third-line agent.

Key Words: atrial fibrillation • atrial flutter • antiarrhythmic agents • heart failure

Abbreviations and Acronyms   AF = atrial fibrillation   AFL = atrial flutter   bid = twice a day   CI = confidence interval   EF = ejection fraction   FDA = Food and Drug Administration   NYHA = New York Heart Association   RR = relative risk

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