Effect of dronedarone vs. placebo on atrial fibrillation progression: apost hocanalysis from ATHENA trial

Abstract

Aims This post hoc analysis of the ATHENA trial (NCT00174785) assessed the effect of dronedarone on the estimated burden of atrial fibrillation (AF)/atrial flutter (AFL) progression to presumed permanent AF/AFL, and regression to sinus rhythm (SR), compared with placebo. Methods and results The burden of AF/AFL was estimated by a modified Rosendaal method using available electrocardiograms (ECG). Cumulative incidence of permanent AF/AFL (defined as ≥6 months of AF/AFL until end of study) or permanent SR (defined as ≥6 months of SR until end of study) were calculated using Kaplan–Meier estimates. A log-rank test was used to assess statistical significance. Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were estimated using a Cox model, adjusted for treatment group. Of the 4439 patients included in this analysis, 2208 received dronedarone, and 2231 placebo. Baseline and clinical characteristics were well balanced between groups. Overall, 304 (13.8%) dronedarone-treated patients progressed to permanent AF/AFL compared with 455 (20.4%) treated with placebo (P < 0.0001). Compared with those receiving placebo, patients receiving dronedarone had a lower cumulative incidence of permanent AF/AFL (log-rank P < 0.001; HR: 0.65; 95% CI: 0.56–0.75), a higher cumulative incidence of permanent SR (log-rank P < 0.001; HR: 1.19; 95% CI: 1.09–1.29), and a lower estimated AF/AFL burden over time (P < 0.01 from Day 14 to Month 21). Conclusion These results suggest that dronedarone could be a useful antiarrhythmic drug for early rhythm control due to less AF/AFL progression and more regression to SR vs. placebo, potentially reflecting reverse remodeling. Clinical trial registration NCT00174785

Unraveling the Complexity: From Molecular Subtypes to Therapeutic Strategies in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation

“…A posthoc analysis of the ATHENA trial showed that dronedarone can be a useful antiarrhythmic drug for early rhythm control, as it reduces the burden of AF/atrial flutter (AFL) progression to permanent AF/AFL and increases the regression to sinus rhythm (SR) compared to placebo [129]. Another posthoc analysis of the ATHENA trial found that dronedarone has both rhythm-and rate-controlling properties, as it prolongs the time to AF/AFL recurrence, reduces the need for electrical cardioversion, and decreases the likelihood of permanent AF/AFL [130].…”

The Correlates of Atrial Fibrillation in a Random Sample of Congolese Inhabitants of the City of Kinshasa, the Democratic Republic of the Congo

“…The gold standard diagnosis of AF is 12-lead ECG recording. Since the examination is difficult to perform in mass field surveys, several tools have been validated for screening with convincing reliability [5][6][7][8][9][10][11][12][13][14]. We used Alivecor Kardia software embedded on a smartphone with the aim to explore the epidemiological profile of AF a poorly recognized disease among the general Congolese partly because such information is not yet available.…”