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Efficacy and safety of dronedarone by atrial fibrillation history duration: Insights from the ATHENA study |
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| Authors: | Carina Blomström-Lundqvist Nassir Marrouche Stuart Connolly Valérie Corp dit Genti Mattias Wieloch Andrew Koren Stefan H. Hohnloser |
| Affiliation: | 1. Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden;2. Section of Cardiology, Tulane University Heart and Vascular Institute, New Orleans, Louisiana, USA;3. Population Health Research Institute, Hamilton, Canada;4. Sanofi-Aventis, Paris, France;5. Sanofi-Aventis, Paris, France Department of Coagulation Disorders, Skåne University Hospital, Lund University, Malmö, Sweden;6. Sanofi, Bridgewater, New Jersey, at the time of the study, USA;7. Department of Cardiology, Division of Clinical Electrophysiology, J. W. Goethe University, Frankfurt, Germany |
| Abstract: | BackgroundAtrial fibrillation/atrial flutter (AF/AFL) burden increases with increasing duration of AF/AFL history.HypothesisOutcomes with dronedarone may also be impacted by duration of AF/AFL history.MethodsIn this post hoc analysis of ATHENA, efficacy and safety of dronedarone vs placebo were assessed in groups categorized by time from first known AF/AFL episode to randomization (ie, duration of AF/AFL history): <3 months (short), 3 to <24 months (intermediate), and ≥ 24 months (long).ResultsOf 2859 patients with data on duration of AF/AFL history, 45.3%, 29.6%, and 25.1% had short, intermediate, and long histories, respectively. Patients in the long history group had the highest prevalence of structural heart disease and were more likely to be in AF/AFL at baseline. Placebo‐treated patients in the long history group also had the highest incidence of AF/AFL recurrence and cardiovascular (CV) hospitalization during the study. The risk of first CV hospitalization/death from any cause was lower with dronedarone vs placebo in patients with short (hazard ratio, 0.79 [95% confidence interval: 0.65‐0.96]) and intermediate (0.72 [0.56‐0.92]) histories; a trend favoring dronedarone was also observed in patients with long history (0.84 [0.66‐1.07]). A similar pattern was observed for first AF/AFL recurrence. No new drug‐related safety issues were identified.ConclusionsPatients with long AF/AFL history had the highest burden of AF/AFL at baseline and during the study. Dronedarone significantly improved efficacy vs placebo in patients with short and intermediate AF/AFL histories. While exploratory, these results support the potential value in initiating rhythm control treatment early in patients with AF/AFL. |
| Keywords: | antiarrhythmic therapy atrial fibrillation atrial flutter dronedarone duration of atrial fibrillation history |