title: Comparison of safety of sotalol versus amiodarone in patients with atrial fibrillation and coronary artery disease.
abstract: Sotalol is a commonly prescribed antiarrhythmic drug (AAD) used for maintaining sinus rhythm in patients with atrial fibrillation (AF). Although randomized studies have found that sotalol can significantly delay time to AF recurrence, its association with mortality is less clear, particularly among those with coronary artery disease. We examined outcomes of 2,838 patients with coronary artery disease and AF. Using Cox proportional hazards modeling, landmark analysis, and time-dependent covariates for drug therapy, we compared cumulative survival among patients treated with sotalol (n = 226), amiodarone (n = 856), or no AAD (n = 1,756). Median follow-up was 4.2 years (interquartile range [IQR] 2.0-7.4). The median age was 68 years (IQR 60-75). Compared with those treated with amiodarone or no AAD, patients treated with sotalol were less likely to be black (6% vs 13% vs 13%) and have a previous myocardial infarction (35% vs 51% vs 48%) or a left ventricular ejection fraction <40% (13% vs 26% vs 21%). In follow-up, persistence of sotalol was limited; 97% of patients treated with sotalol were treated for <25% of the follow-up period. In adjusted analysis accounting for time on therapy, sotalol use was associated with an increased risk of all-cause death compared with no drug (hazard ratio 1.53, 95% confidence interval 1.19 to 1.96, p = 0.0009), but a decreased risk of death compared with amiodarone (hazard ratio 0.72, 95% confidence interval 0.55 to 0.91, p = 0.0141). In conclusion, sotalol therapy was more frequently used in patients with fewer co-morbidities, often discontinued early in follow-up, and was associated with increased mortality compared with no AAD but decreased mortality relative to amiodarone.
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. Electronic address: jonathan.piccini@duke.edu.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Wojdyla
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: John R
authors.initials: JR
authors.lastname: Horton
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Lokhnygina
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Tracy
authors.initials: T
authors.lastname: DeWald
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Nancy
authors.initials: N
authors.lastname: Allen-LaPointe
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Steinberg
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Kevin
authors.initials: K
authors.lastname: Thomas
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.affiliation: Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death / Q000639:trends; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D013015:Sotalol / Q000627:therapeutic use*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D000638:Amiodarone