Appropriate and Inappropriate Use of Dronedarone in 2013

Arrhythmia (B Stambler, Section Editor)

Opinion statement

Dronedarone is a multichannel blocking antiarrhythmic agent that has been shown to prevent atrial fibrillation/flutter (AF/AFl) recurrences in several multi-center trials. In the ANDROMEDA trial, dronedarone treatment increased mortality and cardiovascular hospitalizations patients with decompensated heart failure. In the ATHENA trial, dronedarone was used in elderly high risk patients with paroxysmal or persistent AF/AFl, excluding those with advanced heart failure, cardiovascular hospitalizations were significantly reduced. Dronedarone increased mortality and cardiovascular hospitalizations in a different patient group with permanent AF/AFl. Although organic toxicity from the drug is very rare, post-marketing data has reported rare hepatic toxicity associated with dronedarone use. Current guidelines position dronedarone as a front-line antiarrhythmic in many patients with AF/Fl. However, dronedarone should not be used in patients with advanced heart failure or in permanent AF. Clinical trial results have helped us define appropriate and inappropriate candidates for dronedarone.


Dronedarone Atrial fibrillation Appropriate vs inappropriate ATHENA trial ANDROMEDA trial 

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.•
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  13. 13.•
    Connolly SJ, Camm AJ, Halperin JL, for the PALLAS Investigators, et al. Dronedarone in high risk permanent atrial fibrillation. N Engl J Med. 2011;365:2268–76. PALLAS demonstrated a worsening of cardiovascular outcomes with dronedarone in permanent AF/AFl.PubMedCrossRefGoogle Scholar
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    Joghetaei N, Weirich G, Huber W, Buchler P, Estner H. Acute liver failure with dronedarone. Circ Arrhythm Electrophysiol. 2011;4:592–3. Review of case reports of severe hepatic toxicity possibly secondary to dronedarone.PubMedCrossRefGoogle Scholar
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    Camm AJ, Lip GY, De Caterina R, Savilieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33(21):2719–47. Most recent European guideline reviewing dronedarone’s role after PALLAS.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Penn State Hershey Heart & Vascular Institute, Cardiac Electrophysiology ProgramPenn State University College of MedicineHersheyUSA

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