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Wu VCC, Wang CL, Huang YC, Tu HT, Huang YT, Huang CH, Chen SW, Kuo CF, Hung KC, Chang SH. Cardiovascular outcomes in patients with atrial fibrillation concomitantly treated with antiarrhythmic drugs and non-vitamin k antagonist oral anticoagulants. Europace 2023; 25:euad083. [PMID: 37000581 PMCID: PMC10227765 DOI: 10.1093/europace/euad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/09/2023] [Indexed: 04/01/2023] Open
Abstract
AIMS Limited data compared antiarrhythmic drugs (AADs) with concomitant non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients, hence the aim of the study. METHODS AND RESULTS National health insurance database were retrieved during 2012-17 for study. We excluded patients not taking AADs, bradycardia, heart block, heart failure admission, mitral stenosis, prosthetic valve, incomplete demographic data, and follow-up <3 months. Outcomes were compared in Protocol 1, dronedarone vs. non-dronedarone; Protocol 2, dronedarone vs. amiodarone; and Protocol 3, dronedarone vs. propafenone. Outcomes were acute myocardial infarction (AMI), ischaemic stroke/systemic embolism, intracranial haemorrhage (ICH), major bleeding, cardiovascular death, all-cause mortality, and major adverse cardiovascular event (MACE) (including AMI, ischaemic stroke, and cardiovascular death). In Protocol 1, 2298 dronedarone users and 6984 non-dronedarone users (amiodarone = 4844; propafenone = 1914; flecainide = 75; sotalol = 61) were analysed. Dronedarone was associated with lower ICH (HR = 0.61, 95% CI = 0.38-0.99, P = 0.0436), cardiovascular death (HR = 0.24, 95% CI = 0.16-0.37, P < 0.0001), all-cause mortality (HR = 0.33, 95% CI = 0.27-0.42, P < 0.0001), and MACE (HR = 0.56, 95% CI = 0.45-0.70, P < 0.0001). In Protocol 2, 2231 dronedarone users and 6693 amiodarone users were analysed. Dronedarone was associated with significantly lower ICH (HR = 0.53, 95%=CI 0.33-0.84, P = 0.0078), cardiovascular death (HR = 0.20, 95% CI = 0.13-0.31, P < 0.0001), all-cause mortality (HR 0.27, 95% CI 0.22-0.34, P < 0.0001), and MACE (HR = 0.53, 95% CI = 0.43-0.66, P < 0.0001), compared with amiodarone. In Protocol 3, 812 dronedarone users and 2436 propafenone users were analysed. There were no differences between two drugs for primary and secondary outcomes. CONCLUSION The use of dronedarone with NOACs was associated with cardiovascular benefits in an Asian population, compared with non-dronedarone AADs and amiodarone.
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Affiliation(s)
- Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Chun-Li Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Yu-Chang Huang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Hui-Tzu Tu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Chien-Hao Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kuo-Chun Hung
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
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Di Biase L, Mohanty P, Mohanty S, Santangeli P, Trivedi C, Lakkireddy D, Reddy M, Jais P, Themistoclakis S, Dello Russo A, Casella M, Pelargonio G, Narducci ML, Schweikert R, Neuzil P, Sanchez J, Horton R, Beheiry S, Hongo R, Hao S, Rossillo A, Forleo G, Tondo C, Burkhardt JD, Haissaguerre M, Natale A. Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device. Circulation 2016; 133:1637-44. [DOI: 10.1161/circulationaha.115.019406] [Citation(s) in RCA: 489] [Impact Index Per Article: 61.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
Background—
Whether catheter ablation (CA) is superior to amiodarone (AMIO) for the treatment of persistent atrial fibrillation (AF) in patients with heart failure is unknown.
Methods and Results—
This was an open-label, randomized, parallel-group, multicenter study. Patients with persistent AF, dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, New York Heart Association II to III, and left ventricular ejection fraction <40% within the past 6 months were randomly assigned (1:1 ratio) to undergo CA for AF (group 1, n=102) or receive AMIO (group 2, n=101). Recurrence of AF was the primary end point. All-cause mortality and unplanned hospitalization were the secondary end points. Patients were followed up for a minimum of 24 months. At the end of follow-up, 71 (70%; 95% confidence interval, 60%–78%) patients in group 1 were recurrence free after an average of 1.4±0.6 procedures in comparison with 34 (34%; 95% confidence interval, 25%–44%) in group 2 (log-rank
P
<0.001). The success rate of CA in the different centers after a single procedure ranged from 29% to 61%. After adjusting for covariates in the multivariable model, AMIO therapy was found to be significantly more likely to fail (hazard ratio, 2.5; 95% confidence interval, 1.5–4.3;
P
<0.001) than CA. Over the 2-year follow-up, the unplanned hospitalization rate was (32 [31%] in group 1 and 58 [57%] in group 2;
P
<0.001), showing 45% relative risk reduction (relative risk, 0.55; 95% confidence interval, 0.39–0.76). A significantly lower mortality was observed in CA (8 [8%] versus AMIO (18 [18%];
P
=0.037).
Conclusions—
This multicenter randomized study shows that CA of AF is superior to AMIO in achieving freedom from AF at long-term follow-up and reducing unplanned hospitalization and mortality in patients with heart failure and persistent AF.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00729911.
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Affiliation(s)
- Luigi Di Biase
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Prasant Mohanty
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Sanghamitra Mohanty
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Pasquale Santangeli
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Chintan Trivedi
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Dhanunjaya Lakkireddy
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Madhu Reddy
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Pierre Jais
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Sakis Themistoclakis
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Antonio Dello Russo
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Michela Casella
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Gemma Pelargonio
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Maria Lucia Narducci
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Robert Schweikert
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Petr Neuzil
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Javier Sanchez
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Rodney Horton
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Salwa Beheiry
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Richard Hongo
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Steven Hao
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Antonio Rossillo
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Giovanni Forleo
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Claudio Tondo
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - J. David Burkhardt
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Michel Haissaguerre
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
| | - Andrea Natale
- From Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); Hôpital Cardiologique du Haut Lévêque, Université Victor-Segalen Bordeaux, France (P.J.,
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