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.

April 6th, 2010

• Dronedarone Data Duel

Dronedarone Data Duel: Two separate papers in the Journal of the American College of Cardiology offer starkly contrasting views on the role of dronedarone in clinical practice. In a viewpoint and commentary, David Singh and colleagues review the dronedarone data and conclude that although dronedarone “has the ability to control both rhythm and rate” in AF patients, “the antiarrhythmic efficacy is quite modest compared with placebo and only half as effective compared with the gold standard amiodarone.” They note that the safety profile of the drug in low- and intermediate-risk stable patients is reassuring, however.

Singh et al. conclude that “treatment with antiarrhythmic drugs should generally be considered only when symptoms persist despite adequate rate control.” “When a rhythm-control strategy is desired,” they write that “the available data support only limited use of dronedarone for select patient populations, mostly as a second- or third-line agent in lieu of amiodarone.”

In sharp contrast, an accompanying editorial by Christian Torp-Pedersen and colleagues takes a much sunnier view of the drug. They point out that rhythm control is the strategy often chosen by patients and physicians and conclude that dronedarone is a reasonable option for intermediate-risk patients. And for low-risk patients, they write that “dronedarone provides the only antiarrhythmic drug with a large safety database to prove reasonable safety. The safety knowledge of dronedarone may result in patient and physician preference of dronedarone as first-line therapy, with a possible switch to amiodarone when sinus rhythm is no longer maintained.”

Categories: General


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