title: Comparative effectiveness of antiarrhythmic drugs for rhythm control of atrial fibrillation.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Dingxin
authors.initials: D
authors.lastname: Qin
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Leef
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Mian Bilal
authors.initials: MB
authors.lastname: Alam
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Rattan
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Mohamad Bilal
authors.initials: MB
authors.lastname: Munir
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Divyang
authors.initials: D
authors.lastname: Patel
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Furqan
authors.initials: F
authors.lastname: Khattak
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Adelstein
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Jain
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: sabas@upmc.edu.
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000031:analogs & derivatives / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D000077764:Dronedarone; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D010627:Phenethylamines / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D013015:Sotalol / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013449:Sulfonamides / Q000627:therapeutic use
chemical_list: D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; D013015:Sotalol; D000077764:Dronedarone; D000638:Amiodarone; C063533:dofetilide
keywords: Antiarrhythmic drugs; Atrial fibrillation; Comparative effectiveness