title: Dronedarone in patients with congestive heart failure: insights from ATHENA.
abstract: OBJECTIVE
  Dronedarone is a new multichannel blocking antiarrhythmic drug for treatment of atrial fibrillation (AF). In patients with recently decompensated congestive heart failure (CHF) and depressed LV function, the drug was associated with excess mortality compared with a placebo group. The present study aimed to analyse in detail the effects of dronedarone on mortality and morbidity in AF patients CHF.
  
  
  RESULTS
  We performed a post hoc analysis of ATHENA, a large placebo-controlled outcome trial in 4628 patients with paroxysmal or persistent AF, to evaluate the relationship between clinical outcomes and dronedarone therapy in patients with stable CHF. The primary outcome was time to first cardiovascular (CV) hospitalization or death. There were 209 patients with NYHA class II/III CHF and a left ventricular ejection fraction < or =0.40 at baseline (114 placebo, 95 dronedarone patients). A primary outcome event occurred in 59/114 placebo patients compared with 42/95 dronedarone patients [hazard ratio (HR) 0.78, 95% CI = 0.52-1.16]. Twenty of 114 placebo patients and 12/95 dronedarone patients died during the study (HR 0.71, 95% CI = 0.34-1.44). Fifty-four placebo and 42 dronedarone patients were hospitalized for an intermittent episode of NYHA class IV CHF (HR = 0.78, 95% CI = 0.52-1.17).
  
  
  CONCLUSIONS
  In this post-hoc analysis of ATHENA patients with AF and stable CHF, dronedarone did not increase mortality and showed a reduction of CV hospitalization or death similar to the overall population. However, in the light of the ANtiarrhythmic trial with DROnedarone in Moderate to severe CHF Evaluating morbidity DecreAse study, dronedarone should be contraindicated in patients with NYHA class IV or unstable NYHA classes II and III CHF.
authors.affiliation: Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Theodor-Stern-Kai 7, D 60590 Frankfurt, Germany. Hohnloser@em.uni-frankfurt.de
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: Martin
authors.initials: M
authors.lastname: van Eickels
authors.forename: Christophe
authors.initials: C
authors.lastname: Gaudin
authors.forename: Richard L
authors.initials: RL
authors.lastname: Page
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D003404:Creatinine / Q000378:metabolism; D000077764:Dronedarone; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality
chemical_list: D000889:Anti-Arrhythmia Agents; D003404:Creatinine; D000077764:Dronedarone; D000638:Amiodarone