After AF ablation, dronedarone may be safer, more effective than sotalol
After atrial fibrillation ablation, dronedarone was associated with lower risk for recurrent hospitalizations and repeat AF ablations compared with sotalol, researchers reported.
“Recurrent atrial tachyarrhythmias are particularly prevalent in the first 3 months after ablation because of myocardial injury and inflammation, a period known as the recovery or blanking phase,” John Marcus Wharton, MD, director of the Frank P. Tourville Sr. Arrhythmia Center at the Medical University of South Carolina, and colleagues wrote. “Thus, treatment with antiarrhythmic drugs is frequently needed during and even beyond the recovery phase after ablation. Recurrent atrial tachyarrhythmias after ablation also result in the need for recurrent hospitalizations, cardioversions and repeat AF ablations. The long-term cardiovascular benefits with comprehensive rhythm control with AADs and AF ablation, however, are still to be established.”
According to the study, dronedarone and sotalol are common antiarrhythmic drugs with differing pharmacological effects; however, they are indicated and used in similar patient populations.
To elucidate differences in the efficacy and safety of dronedarone and sotalol after AF ablation, researchers conducted an analysis that included 30,696 patients who underwent ablation, of whom 2,086 were treated with dronedarone and 3,665 with sotalol. Outcomes of interest included CV hospitalization, proarrhythmia, repeat ablation and cardioversion.
After propensity-score matching, the researchers paired 1,815 patients who received dronedarone 1:1 with those who received sotalol.
After AF ablation, risk for CV hospitalization was lower among patients who received dronedarone compared with those on sotalol at:
- 3 months (adjusted HR = 0.77; 95% CI, 0.61-0.97);
- 6 months (aHR = 0.76; 95% CI, 0.63-0.93); and
- 12 months (aHR = 0.7; 95% CI, 0.66-0.93).
Moreover, researchers observed lower proarrhythmia risk in the dronedarone group compared with the sotalol group at:
- 3 months (aHR = 0.76; 95% CI, 0.64-0.9);
- 6 months (aHR = 0.8; 95% CI, 0.7-0.93); and
- 12 months (aHR = 0.83; 95% CI, 0.73-0.94).
Risk for repeat ablation (P = .06) and cardioversion (P = .42) did not differ between dronedarone compared with sotalol.
“The difference in atrial tachyarrhythmia-related hospitalizations was greatest in the first 3 months after ablation, when there is typically a high burden of atrial tachyarrhythmia because of ablation-induced myocardial injury, inflammation and autonomic changes,” the researchers wrote. “Dronedarone-treated patients had a much better safety profile after ablation compared with sotalol patients because of lower rates of combined proarrhythmia, predominantly driven by lower rates of bradycardic proarrhythmia and need for pacemaker implantation. From our data, dronedarone appears to be a more effective and safer alternative after ablation than sotalol.”
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