Comparative outcomes of amiodarone and dronedarone in atrial fibrillation: a real-world retrospective cohort study

Q: What are the key findings of this study?

Amiodarone was associated with a higher risk of all-cause mortality compared to dronedarone.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: atrial fibrillation (n=4931). Intervention: Amiodarone vs. Dronedarone. Primary outcome: all-cause mortality (HR 6.98, 95% CI 2.89-16.84, p=<0.001).

Q: What does this research mean for the field?

In patients with atrial fibrillation, amiodarone is associated with significantly higher all-cause mortality and lower drug adherence compared to dronedarone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This study evaluates the long-term outcomes of amiodarone compared to dronedarone in atrial fibrillation management.

A Akuka; T Stahi; M Geist; U Nussunovitch; G Zacay; R Rubinshtien; H Steiner

doi:10.1093/europace/euag105.110

June 1, 2026EP EuropaceOpen Access

Comparative outcomes of amiodarone and dronedarone in atrial fibrillation: a real-world retrospective cohort study

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Key result

Amiodarone linked to ~598% higher all-cause mortality risk vs dronedarone.

HR 6.98
95% CI 2.89-16.84
P<0.001
n=4,931

Figures

Why the study?

Amiodarone and dronedarone are key rhythm control options in structural heart disease, but comparisons between treatments with these agents are limited.

Does dronedarone improve survival compared to amiodarone in adult patients with atrial fibrillation?

Key Points

This study evaluates the long-term outcomes of amiodarone compared to dronedarone in atrial fibrillation management.
Retrospective cohort analysis of patients initiating amiodarone or dronedarone from 2014 to 2021.
Primary outcome was all-cause mortality; secondary outcomes included hospitalizations and other clinical events.
Final cohort included 4739 patients on amiodarone and 192 patients on dronedarone.
All-cause mortality was higher in the amiodarone group (18%) compared to dronedarone (2.6%), p<0.001.
Amiodarone showed significantly lower drug adherence over time (557.6 days) than dronedarone (693.4 days), p=0.011.
Independent analysis indicated amiodarone was linked to significantly higher mortality (HR 6.98, 95% CI 2.89-16.84, p<0.001).

Study Design

Type

Cohort (n=4,931)

Structured PICO

Does dronedarone improve survival compared to amiodarone in adult patients with atrial fibrillation?

P

Population

4,931 adult patients initiating amiodarone or dronedarone for atrial fibrillation management between 2014 and 2021.

E

Exposure

Dronedarone

C

Comparator

Amiodarone

O

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 6.98 (95% CI 2.89–16.84)

Absolute Event Rate: 18% vs 2.6%

p-value: p=<0.001

In a real-world cohort, dronedarone was associated with superior long-term survival and better therapeutic adherence compared to amiodarone in patients with atrial fibrillation.

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Implication

Dronedarone may confer survival advantage over amiodarone in real-world AF; hypothesis-generating and should not yet change practice.

Abstract

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Discussion

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Cite This Study

Akuka et al. (2026) conducted a cohort in atrial fibrillation (n=4,931). Amiodarone vs. Dronedarone was evaluated on all-cause mortality (HR 6.98, 95% CI 2.89-16.84, p=<0.001). Amiodarone was associated with a higher risk of all-cause mortality compared to dronedarone.

synapsesocial.com/papers/6a3f9809125782b61d865c0c https://doi.org/10.1093/europace/euag105.110

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Comparative outcomes of amiodarone and dronedarone in atrial fibrillation: a real-world retrospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Comparative outcomes of amiodarone and dronedarone in atrial fibrillation: a real-world retrospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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