Dronedarone: An alternate choice to sotalol and amiodarone in the treatment of atrial fibrillation/flutter in patients who have coronary heart disease

摘要

A large number of patients with atrial fibrillation (AF) have coronary heart disease (CHD) or concomitant risk factors. In ATHENA (A placebo controlled, double blind Trial to assess the efficacy of dro-nedarone for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation and flutter), 30% of the patients had CHD. The results of the CAST (Cardiac Arrhythmia Suppression Trial) led physicians to carefully select antiar-rhythmic drugs that can be used safely in the CHD population. The clinical trials have demonstrated neutral mortality risk in CHD patients treated with sotalol, amiodarone, dofetilide, and most recently dronedarone. Based on these data, these drugs have been recommended by the guidelines for use in the CHD population. Dofetilide is only available in the USA and not included in the ESC guidelines. Thus, physicians in most countries only have sotalol, amiodarone, and dronedarone as therapeutic options for the treatment of AF in patients with CHD. Owing to the over prescribing of amiodarone and its potential adverse effects, the revised guidelines downgraded amiodarone as a second choice in many patient subgroups with AF.