The Role of Dronedarone in the Treatment of Atrial Fibrillation/Flutter in the Aftermath of PALLAS
Gerald V. Naccarelli and Peter R. Kowey
Affiliation: Penn State University College of Medicine, Penn State Hershey Heart & Vascular Institute, Cardiac Electrophysiology Program, 500 University Drive, Room H1511, Hershey PA 17033, USA.
Keywords: Atrial fibrillation, dronedarone.
Dronedarone is an amiodarone analog that differs structurally from amiodarone in that the iodine moiety was
removed and a methane-sulfonyl group was added. These modifications reduce thyroid and other end-organ adverse effects
and makes dronedarone less lipophilic, with a shorter half-life. Dronedarone has been shown to prevent atrial fibrillation/
flutter (AF/AFl) recurrences in several multi-center trials. In addition to its rhythm control properties, dronedarone
has rate control properties. In patients with decompensated heart failure, dronedarone treatment increased mortality and
cardiovascular hospitalizations. When dronedarone was used in elderly high risk AF/AFl patients, excluding those with
advanced heart failure, cardiovascular hospitalizations were significantly reduced. The results of the PALLAS trial suggest
that dronedarone should not be used in the long-term treatment of patients with permanent AF. Post-marketing data
have demonstrated rare hepatic toxicity to be associated with dronedarone use. Updated practice and regulatory guidelines
have positioned dronedarone as a front-line antiarrhythmic in many patients with AF/Fl. However, the drug should not be
used in patients with advanced heart failure and in patients who develop permanent AF.
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