Addressing the management of atrial fibrillation – a systematic review of the role of dronedarone Full Text
International Journal of General Medicine, 05/30/2012
Evidence Based Medicine
Podda GM et al. – Like most antiarrhythmic drugs, dronedarone reduces the recurrence of Atrial fibrillation (AF) in patients with paroxysmal or persistent AF as compared to placebo. However, relapse rates in the first year of therapy are high. Moreover, dronedarone showed to be less effective than amiodarone. Finally, dronedarone should be avoided in patients with permanent AF and a high risk for cardiovascular events or severe congestive heart failure.Methods
- Electronic databases (MEDLINE, Embase, and Central) were searched up to November 2011 with no language restrictions.
- The authors included randomized controlled trials in which dronedarone was compared to placebo or other drugs in patients with AF.
- Internal and external validity was assessed.
- The authors identified seven papers corresponding to eight randomized controlled trials.
- The DAFNE, EURIDIS/ADONIS, and ATHENA trials demonstrated a reduction of AF recurrence with dronedarone as compared to placebo in patients with nonpermanent AF.
- The DIONYSOS study showed that dronedarone is less effective for the prevention of recurrent AF but improved tolerability as compared to amiodarone.
- Considering patients with permanent AF, the ERATO trial showed that dronedarone had rate–control effects while the PALLAS study was stopped early since stroke, myocardial infarction, systemic embolism, or death from cardiovascular causes were significantly more frequent in subjects treated with dronedarone as compared to placebo.
- The ANDROMEDA trial included patients with recent hospitalization for heart failure and was terminated early because of excess of deaths in the dronedarone group.