title: [Dronedarone: a real innovation or a mere second-best choice? How to find the way among guidelines, regulatory agencies and daily clinical practice].
abstract: Dronedarone is the antiarrhythmic drug with the most complete and wide literature preceding its marketing. Most of these studies showed a good efficacy along with an excellent risk profile, especially in low- and medium-risk patients. Recently, updates of European, American and even Italian guidelines gave dronedarone its own spot into the antiarrhythmic armamentarium, recommending its use both for rhythm control and rate control in non-permanent atrial fibrillation. In Italy, however, dronedarone prescription is still possible only when amiodarone is not tolerated, making dronedarone a mere second choice of its older "relative". Moreover, patients taking dronedarone must undergo a strict alanine aminotransferase and bilirubin follow-up, which usefulness in predicting drug-induced liver damage (probably idiosyncratic in nature and therefore unpredictable) is far from demonstrated. The aim of this review is to sum up actual evidences on dronedarone, describe how these evidences had been differently transposed by panel of experts and drug agencies into guidelines and recommendations, and define the current difficulties encountered by the cardiologist in the correct use of this new antiarrhythmic agent in clinical practice.
authors.affiliation: Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.forename: Federico
authors.initials: F
authors.lastname: Guerra
authors.forename: Cesare
authors.initials: C
authors.lastname: Antenucci
authors.forename: Roberto
authors.initials: R
authors.lastname: Antonicelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Bocconcelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Paolo
authors.initials: P
authors.lastname: Busacca
authors.forename: Nino
authors.initials: N
authors.lastname: Ciampani
authors.forename: Stefano
authors.initials: S
authors.lastname: Della Casa
authors.forename: Domenico
authors.initials: D
authors.lastname: Gabrielli
authors.forename: Marcello
authors.initials: M
authors.lastname: Galvani
authors.forename: Massimo
authors.initials: M
authors.lastname: Margheri
authors.forename: Francesco
authors.initials: F
authors.lastname: Melandri
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.forename: Gian Piero
authors.initials: GP
authors.lastname: Perna
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Pieri
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Piovaccari
authors.forename: Andrea
authors.initials: A
authors.lastname: Pozzolini
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.forename: Giovanni Quinto
authors.initials: GQ
authors.lastname: Villani
mesh_terms: D000465:Algorithms; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000077764:Dronedarone; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced*; D008111:Liver Function Tests; D017410:Practice Guidelines as Topic
chemical_list: D000889:Anti-Arrhythmia Agents; D000077764:Dronedarone; D000638:Amiodarone