Dronedarone treatment following cardioversion in patients with atrial fibrillation/flutter: A post hoc analysis of the EURIDIS and ADONIS trials

Munveer Thind*, Harry J. Crijns, Gerald V. Naccarelli, James A. Reiffel, Valerie Corp Dit Genti, Mattias Wieloch, Andrew Koren, Peter R. Kowey

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction The phase 3 EURIDIS and ADONIS studies evaluated dronedarone for atrial fibrillation (AF)/atrial flutter (AFL) recurrence in patients with nonpermanent AF. Here we assessed whether patient characteristics and/or treatment outcomes in these studies differed based on the need for cardioversion before randomization.

Methods Time to adjudicated first AF/AFL recurrence, symptomatic recurrence, cardiovascular hospitalization/death, and AF hospitalization, and safety were assessed by cardioversion status.

Results Of 1237 patients randomized (2:1 dronedarone:placebo), 364 required baseline cardioversion (dronedarone 243, placebo 121). Patients requiring cardioversion had a greater prevalence of cardiovascular comorbidities and shorter times to first AF/AFL recurrence compared with those not requiring cardioversion. Dronedarone was associated with longer median time to first AF/AFL recurrence vs placebo regardless of cardioversion status (cardioversion: 50 vs 15 days, hazard ratio [HR] 0.76; 95% confidence interval [CI], 0.59-0.97; P = .02; non-cardioversion: 150 vs 77 days, HR 0.76; 95% CI, 0.64-0.90; P <.01). Dronedarone was similarly associated with prolonged median time to symptomatic recurrence vs placebo in the cardioversion (347 vs 87 days, HR 0.65; 95% CI, 0.49-0.87) and non-cardioversion (288 vs 120 days, HR 0.74; 95% CI, 0.62-0.90) populations. Risk of cardiovascular hospitalization/death and first AF hospitalization was lower with dronedarone vs placebo regardless of cardioversion status, but differences were not statistically significant. The safety of dronedarone was similar in both groups.

Conclusion Patients requiring baseline cardioversion represent a distinct population, having more underlying cardiovascular disease and experiencing a shorter time to AF/AFL recurrences. Dronedarone was associated with improved efficacy vs placebo regardless of cardioversion status.

Original languageEnglish
Pages (from-to)1022-1030
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume31
Issue number5
DOIs
Publication statusPublished - May 2020

Keywords

  • ACC/AHA/ESC 2006 GUIDELINES
  • AMERICAN-COLLEGE
  • ASSOCIATION TASK-FORCE
  • DOFETILIDE
  • EFFICACY
  • EURO HEART SURVEY
  • MAINTENANCE
  • MANAGEMENT
  • RISK-FACTORS
  • SINUS RHYTHM
  • antiarrhythmic drug
  • atrial fibrillation
  • atrial flutter
  • cardioversion
  • dronedarone
  • AMIODARONE
  • CARDIOLOGY

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