Abstract
In the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS) study, dronedarone use was associated with an excess risk of stroke, cardiovascular death and hospitalizations. However, an increased level in the serum digoxin level was observed in the dronedarone arm, as it is a potent inhibitor of the P-glycoprotein transport system. The PALLAS subanalysis suggests that digoxin-dronedarone interaction was responsible for the higher arrhythmic death rate observed in the trial. These data are consistent with several other studies that demonstrate the potential hazard of the use of digoxin in heart failure and/or atrial fibrillation. One must consider other safer alternatives before prescribing digoxin in atrial fibrillation patients.
Highlights
Antiarrhythmic drug therapy remains the cornerstone for the management of atrial fibrillation (AF)
In the trial to Assess the Efficacy of Dronedarone 400 mg BID for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients with Atrial Fibrillation/Atrial Flutter (ATHENA), dronedarone use in patients with non-permanent AF was associated with significant reduction in the rate of composite end point of death from cardiovascular causes and hospitalization due to cardiovascular events.[2]
In the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS), dronedarone use was associated with an excess risk of stroke, cardiovascular death and hospitalizations.[3]
Summary
Antiarrhythmic drug therapy remains the cornerstone for the management of atrial fibrillation (AF). In the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS), dronedarone use was associated with an excess risk of stroke, cardiovascular death and hospitalizations.[3] an increased level in the serum digoxin level was observed in the dronedarone arm. Hospitalization for heart failure occurred in 43 patients in the dronedarone group and 24 in the placebo group (hazard ratio, 1.81; 95% CI, 1.10 to 2.99; P 1⁄4 0.02).
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