Dronedarone for the management of atrial fibrillation

Atrial fibrillation is a common arrhythmia associated with increased cardiovascular mortality and morbidity including stroke, heart failure and hospitalisations. Major studies on atrial fibrillation have shown no significant difference between rhythm and rate control in terms of mortality. However, rate control treatment may be insufficient to prevent morbidity in a number of patients. Amiodarone is generally considered the agent with the best efficacy for maintaining normal sinus rhythm. Despite amiodarone's efficacy, its use is often limited by its side effect profile and it is not currently recommended as the first choice antiarrhythmic agent, except in patients with heart failure or congenital heart disease. Dronedarone is a noniodinated benzofuran derivative of amiodarone that has been recently approved by Swissmedic for management of patients with atrial fibrillation or atrial flutter. Structural modification of dronedarone was introduced to decrease lipophilicity, shorten the half-life and minimise non-cardiovascular toxicity as compared to amiodarone. This article reviews the pharmacology, adverse effects and clinical evidence available to date on the use of dronedarone in the management of atrial fibrillation.