Abstract
Atrial fibrillation (AF) is an arrhythmia with severe consequences for patients in terms of quality of life and survival. Achieving sinus rhythm (SR) through the use of electrocardioversion or rate control drugs is the first-choice strategy for most AF patients. However, maintaining patients in SR has a low success rate, and patients often revert to AF. Antiarrhythmic drugs are frequently used to maintain sinus rhythm, but are also associated with proarrhythmia and a higher risk of morbidity and mortality. Dronedarone is an antiarrhythmic drug that has been evaluated in a number of trials and may have benefits over other antiarrhythmic drugs in terms of a lower proarrhythmic potential. The ATHENA trial has assessed the efficacy and safety of dronedarone in treating patients with AF. Dronedarone was shown to reduce the number of hospitalisations or deaths due to cardiovascular events in patients with AF. Its benefit goes beyond purely achieving SR. Moreover, as ATHENA enrolled typical AF patients and examined events that have a direct impact on quality of life, it can be argued that it better represented the real-world setting. This article examines the evidence from ATHENA in light of other AF trials, and discusses the validity of the outcome measures used.
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