CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

December 20th, 2010

Dronedarone, Rate Control, and Catheter Ablation Incorporated in Updated AF Guidelines

A focused update on the guidelines for the management of atrial fibrillation has been released by the American College of Cardiology, American Heart Association, and Heart Rhythm Society. Most notably, the new guidelines incorporate recent data from clinical trials evaluating dronedarone, clopidogrel, strict rate control, and catheter ablation. Here are the major highlights:

  • Dronedarone can reduce CV hospitalizations related to AF but should not be given to patients with class IV heart failure or those who have had a recent episode of decompensated heart failure.
  • Clopidogrel in addition to aspirin “might be considered” for stroke prevention in patients who cannot take warfarin.
  • Strict heart rate control is no better than lenient rate control.
  • Catheter ablation gains a class 1 recommendation when performed in experienced centers for selected patients who have failed antiarrhythmic drug therapy and have normal or mildly dilated left atria, normal or mildly reduced LV function, and no severe pulmonary disease. Catheter ablation is also a reasonable option to treat symptomatic persistent AF and symptomatic paroxysmal AF in patients with significant  left atrial dilation or with significant LV dysfunction.

Categories: Electrophysiology
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4 Responses to “Dronedarone, Rate Control, and Catheter Ablation Incorporated in Updated AF Guidelines”

  1. VAZHA AGLADZE, MD., PhD says:
    December 21, 2010 at 1:57 am

    i’m revewer team member and I declare, that Dronedarone still isn’t worth for IA recomendation, it’s my personal and evidence based opinion

    Vazha Agladze

    Competing interests pertaining specifically to this post, comment, or both:
    No conflict of interest

  2. Madhu Reddy, MD says:
    December 21, 2010 at 8:28 pm

    I agree with you Dr. Agladze, that is why Dronedarone is not a Class IA indication in the statement. It is a Class IIA; but it is in par with the other antiarrhythmics and I am not sure if it is appropriate.

    Competing interests pertaining specifically to this post, comment, or both:
    None

  3. Brian Malm, MD says:
    December 27, 2010 at 9:59 am

    All of the antiarrhythmics are suboptimal in terms of sustaining sinus rhythm long-term in the majority of patients with atrial fibrillation. Ablation should really be first-line therapy in most patients in whom a rhythm-control strategy is needed.

  4. David Powell , md, facc says:
    January 5, 2011 at 8:08 pm

    Recent results re recurrent afib several years after ablation and the 1/1000 mortality risk temper my universal enthusiasm for ablation as a first line approach. Dronedarone to my knowlege has never been shown to be of comparable efficacy to any other antiarrhythmic. In my experience…its not that effective. I don’t like the chf issues..I don’t understand them. I don’t really understand the hospitalization endpoint success either. I want more data.

    Competing interests pertaining specifically to this post, comment, or both:
    None