Efficacy and safety of dronedarone by atrial fibrillation history duration: Insights from the ATHENA study

Carina Blomström-Lundqvist, Nassir Marrouche, Stuart Connolly, Valérie Corp Dit Genti, Mattias Wieloch, Andrew Koren, Stefan H Hohnloser, Carina Blomström-Lundqvist, Nassir Marrouche, Stuart Connolly, Valérie Corp Dit Genti, Mattias Wieloch, Andrew Koren, Stefan H Hohnloser

Abstract

Background: Atrial fibrillation/atrial flutter (AF/AFL) burden increases with increasing duration of AF/AFL history.

Hypothesis: Outcomes with dronedarone may also be impacted by duration of AF/AFL history.

Methods: In 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).

Results: Of 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.

Conclusions: Patients 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.

Conflict of interest statement

Outside the submitted work, Carina Blomström‐Lundqvist reports consulting fees from Bayer, Boehringer Ingelheim, Boston Scientific, Cardiome, Medtronic, MSD, Pfizer, and Sanofi‐Aventis. Nassir Marrouche reports grants and/or consulting fees from Abbott, Biosense, Boston Scientific, and Medtronic. Stuart Connolly reports consulting fees from Sanofi‐Aventis. Stefan Hohnloser reports consulting fees from Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Pfizer, Sanofi‐Aventis, and Zoll. Andrew Koren was a previous employee of Sanofi. Mattias Wieloch, and Valérie Corp dit Genti are employees of Sanofi.

© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

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Source: PubMed

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