Dronedarone – a new and good amiodarone? Review article
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Abstract
Dronedarone is a noniodinated benzofuran derivative of amiodarone and thus does not cause iodine-related adverse reactions. Unlike amiodarone, dronedarone exerts only a very little impact on the QT interval, and proarrhythmia has not been observed. Dronedarone is a multichanel blocker of the following ion currents: potassium (Kr, Ks, KI, KACh), L-type calcium and peak sodium. It has been proven that dronedarone maintains a sinus rhythm after cardioversion of atrial fibrillation (AF) in patients without any underlying structural heart disease. ATHENA study revealed that dronedarone reduces both cardiovascular mortality and hospitalization rates in patients with AF. It has been demonstrated in ERATO study that this drug is also very useful in a ventricular rate control in subjects with permanent AF. However, although dronedarone is not as effective as amiodarone in the sinus rhythm maintenance after the cardioversion of AF, it is much better tolerable and demonstrates a more favourable survival profile. The usefulness of dronedarone in heart failure patients has been assessed in ANDROMEDA trial. Increased mortality was observed within the group of subjects treated with dronedarone, therefore currently it not recommended in heart failure patients.
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References
2. Patel Ch., Yan G., Kowey P.R.: Dronedarone. Circulation 2009; 120: 636-644.
3. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Eur. Heart J. 2006; 27: 1979-2030.
4. Benjamin E.J., Wolf P.A., D’Agostino R.B. et al.: Impact of Atrial Fibrillation on the Risk of Death: The Framingham Heart Study. Circulation 1998; 98: 946-952.
5. Singh B.N., Singh S.N., Reda D.J. et al.: Amidarone versus sotalol for atrial fibrillation. N. Engl. J. Med. 2005; 352: 1861-1972.
6. Zimetbaum P.: Amiodarone for atrial fibrillation. N. Engl. J. Med. 2007; 356: 935-41.
7. Laughlin J.C., Kowey P.R.: Dronedarone: A New Treatment for Atrial Fibrillation. J. Cardiovasc. Electrophysiol. 2008; 19: 1220-1226.
8. Touboul P., Brugada J., Capucci A. et al.: Dronedarone for prevention of atrial fibrillation: A dose-ranging study. Eur. Heart J. 2003; 24: 1481-1487.
9. Singh B.N., Hohnloser S.H., Connolly S.J. et al.: The EURIDIS and ADONIS Trials: Dronedarone for Maintaining Sinus Rhythm in Patients with Atrial Fibrillation/Flutter. Circulation 2004; 110 (suppl): III-741.
10. Davy J.M., Herold M., Hoglund C. et al.: Dronedarone for the control of ventricular rate in permanent atrial fibrillation: the Efficacy and safety of dRonedArone for the cOntrol of ventricular rate during atrial fibrillation (ERATO) study. Am. Heart J. 2008; 156: 527.e1-9.
11. Hohnloser S.H., Crijns H.J., van Eickels M. et al.: Effect of dronedarone on cardiovascular events in atrial fibrillation. N. Engl. J. Med. 2009; 360: 668-78.
12. Connolly S.J., Crijns H.J., Torp-Pedersen C. et al.: Analysis of stroke in ATHENA: a placebo-controlled, double-blind, parallel-arm trial to assess the efficacy of dronedarone 400 mg BID for the prevention of cardiovascular hospitalization or death from any cause in patients with atrial fibrillation/atrial flutter. Circulation 2009; 120: 1174-1180.
13. Sanofi-Aventis. DIONYSOS study results showed the respective profiles of dronedarone and amiodarone [press release]. December 28, 2008.
14. Piccini J.P., Hasselblad V., Peterson E.D. et al.: Comparative Efficacy of Dronedarone and Amiodarone for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation. J. Am. Coll. Cardiol. 2009; 54: 1089-95.
15. Kober L., Torp-Pedersen C., McMurray J. et al.: Increased mortality after dronedaron therapy for severe heart failure. N. Engl. J. Med. 2008; 358: 2678-87.