Comparative effectiveness of antiarrhythmic drugs for rhythm control of atrial fibrillation

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• 作者：Dingxin Qin ; MD ; George Leef ; MD ; Mian Bilal Alam ; MD ; Rohit Rattan ; MD ; Mohamad Bilal Munir ; MD ; Divyang Patel ; MD ; Furqan Khattak ; MD ; Evan Adelstein ; MD ; Sandeep K. Jain ; MD ; Samir Saba ; MD ; FACC ; FHRS ; ^{sabas@upmc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Antiarrhythmic drugs ; Atrial fibrillation ; Comparative effectiveness
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：67
• 期：5
• 页码：471-476
• 全文大小：1413 K

文摘

Although there are many different antiarrhythmic drugs (AADs) approved for rhythm management of atrial fibrillation (AF), little comparative effectiveness data exist to guide drug selection.

Methods

We followed 5952 consecutive AF patients who were prescribed amiodarone (N = 2266), dronedarone (N = 488), dofetilide (N = 539), sotalol (N = 1718), or class 1C agents (N = 941) to the primary end point of AF recurrence.

Results

Median follow-up time was 18.2 months (range 0.1–101.6 months). Patients who were prescribed amiodarone had the highest, while patients on class 1C agents had the lowest baseline CHA₂DS₂-VASc score, Charlson comorbidity index, and burden of comorbid illnesses including coronary artery disease, congestive heart failure, diabetes mellitus, hyperlipidemia, chronic obstructive lung disease, chronic kidney disease, or cancer (p < 0.05 for all comparisons). After adjusting for baseline characteristics, using dronedarone as benchmark, amiodarone [hazard ratio (HR) 0.58, p < 0.001], class 1C agents (HR 0.70, p < 0.001), and sotalol (HR 0.79, p = 0.008), but not dofetilide (HR 0.87, p = 0.178) were associated with less AF recurrence. In addition, compared to dronedarone, amiodarone and class 1C agents were associated with lower rates of admissions for AF (HR 0.55, p < 0.001 for amiodarone; HR 0.71, p = 0.021 for class 1C agents) and all-cause mortality was lowest in patients treated with class 1C agents (HR 0.42, p = 0.018). The risk of stroke was similar among all groups.

Conclusion

Compared with dronedarone, amiodarone, class 1C agents, and sotalol are more effective for rhythm control, while dofetilide had similar efficacy. These findings have important implications for clinical practice.