Dronedarone Versus Amiodarone for Atrial Fibrillation Recurrence After Catheter Ablation

Background: Atrial fibrillation (AF) recurrence remains common after catheter ablation. We performed a meta-analysis of reconstructed time-to-event data to compare the efficacy and safety of dronedarone versus amiodarone for preventing AF recurrence following catheter ablation. Methods: PubMed, Scopus, Web of Science, and Cochrane Library were systematically searched from inception to June 2026. Studies comparing dronedarone and amiodarone after AF ablation were included. The primary outcome was AF recurrence, analyzed using reconstructed individual patient time-to-event data derived from published Kaplan-Meier curves and pooled as hazard ratios (HRs) with 95% confidence intervals (CIs). Dichotomous outcomes were analyzed using risk ratios (RRs) with 95 % confidence intervals (CIs). Results: Four studies involving 887 patients were included. Reconstructed time-to-event analysis showed no significant difference between dronedarone and amiodarone in AF recurrence after catheter ablation (HR: 1.06, 95% CI: 0.75-1.50, P = 0.74). Likewise, no significant differences were observed in blanking-period atrial tachyarrhythmia recurrence (RR: 1.12, 95% CI: 0.86-1.44, P = 0.40), bradycardia (RR: 0.98, 95% CI: 0.50-1.95, P = 0.96), any drug-related adverse events (AEs) (RR: 1.42, 95% CI: 0.32-6.22, P = 0.64), or stroke (RR: 0.51, 95% CI: 0.02-11.26, P = 0.66). However, dronedarone was associated with significantly higher risks of gastrointestinal AEs (RR: 7.72, 95% CI: 2.10-28.37, P = 0.002) and dermatological AEs (RR: 4.20, 95% CI: 1.06-16.53, P = 0.04). Conclusions: Dronedarone and amiodarone demonstrated comparable efficacy in preventing AF recurrence after catheter ablation. While overall safety outcomes were similar, dronedarone was associated with increased gastrointestinal and dermatological AEs