Benefit-risk assessment of current antiarrhythmic drug therapy of atrial fibrillation

Efficacy and safety of dronedarone in patients previously treated with other antiarrhythmic agents

BACKGROUND

Currently available antiarrhythmic drugs (AADs) for the prevention of atrial fibrillation (AF)/atrial flutter (AFL) suffer from incomplete efficacy and poor tolerability.

HYPOTHESIS

Dronedarone could represent an effective and safe option in patients previously treated with AADs, especially class Ic AADs and sotalol.

METHODS

Retrospective analysis of 2 double-blind, parallel-group trials (EURIDIS [European Trial in Atrial Fibrillation or Flutter Patients Receiving Dronedarone for the Maintenance of Sinus Rhythm] and ADONIS [American-Australian-African Trial With Dronedarone in Atrial Fibrillation or Flutter Patients for the Maintenance of Sinus Rhythm]) comparing the efficacy and safety of dronedarone with placebo over 12 months. The primary end point was AF/AFL recurrence in patients previously treated with another AAD that was discontinued for whatever reason prior to randomization.

RESULTS

In patients previously treated with any AADs, dronedarone decreased the risk of AF recurrence by 30.4% vs placebo (hazard ratio [HR]: 0.70; 95% confidence interval [CI]: 0.59-0.82; P < 0.001). In patients previously treated with a class Ic agent, dronedarone decreased the risk of recurrence by 31.4% (HR: 0.69; 95% CI: 0.53-0.89; P = 0.004), whereas in patients previously treated with sotalol, dronedarone showed a trend toward a decrease of risk of recurrence (HR: 0.86; 95% CI: 0.67-1.11; P = 0.244). Dronedarone was equally effective irrespective of whether class Ic or sotalol were stopped for lack of efficacy or adverse events (AEs). Discontinuation rates were similar in the 2 groups (55.9% vs 43.1%), as were incidence of AEs and serious AEs.

CONCLUSIONS

Dronedarone seems to be effective in preventing AF recurrences in patients without permanent AF previously treated with other AADs, even if those were discontinued for lack of efficacy. Dronedarone appears to be well tolerated even in patients who already had tolerability issues with AADs.

Co-existence of Atrial Fibrillation with Myocardial Infarction - Unhealthy Combination

Atrial fibrillation (AF) is the most common arrhythmia with increasing prevalence and incidence. As our population ages, modern treatment options and decreased case-fatality of cardiovascular diseases are likely to increase the number of patients at risk for AF. AF is a frequent co-existing complication ofmyocardial infarction (MI). The onset of AF in the setting of AMI requires immediate intervention which should be individualized for each patient. AF associated with MI influences the in-hospital, medium- and long-term mortality. This brief review, based on 41 reports published between 1970 and 2011, focuses on incidence and mortality in patients with AF in MI setting. Possible mechanisms of AF in MI and treatment options are also discussed.