Comparisons of Hospitalization Rates Among Younger AF Patients Receiving Different Antiarrhythmic Drugs | Journal Scan

Study Questions:

How do hospitalization rates for atrial fibrillation (AF) differ with the use of different rhythm-control agents?


A commercial database was used to identify 8,562 patients <65 years of age (mean age 56 years) without coronary artery disease or heart failure who received a first prescription for a rhythm-control agent after the onset of a new diagnosis of AF. The antiarrhythmic drugs were classified as a Class Ic drug (flecainide or propafenone), amiodarone, sotalol, and dronedarone. The primary outcome was time to AF hospitalization.


AF hospitalizations were significantly more common with dronedarone than with Class Ic drugs (hazard ratio [HR], 1.59), amiodarone (HR, 2.63), and sotalol (HR, 1.72). Amiodarone was associated with significantly fewer AF hospitalizations compared to Class Ic drugs (HR, 0.68) and sotalol (HR 0.63). All-cause hospitalizations did not differ between the different drugs. Non-AF cardiovascular hospitalizations were significantly more likely with the use of amiodarone compared to Class Ic drugs (HR, 1.26).


Hospitalizations for AF in patients younger than 65 years of age who do not have structural heart disease are least likely during treatment with amiodarone and most likely with dronedarone.


The criterion for an AF hospitalization in this study was any hospitalization in which the primary diagnosis was listed as AF. All evidence indicates that amiodarone is the most effective rhythm-control agent available, and the results of this study are consistent with this. There have been no randomized studies of dronedarone versus flecainide or propafenone. The results of this study suggest that dronedarone either is less efficacious or more often has serious adverse effects than Class Ic agents.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), EP Basic Science, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Anti-Arrhythmia Agents, Amiodarone, Atrial Fibrillation, Coronary Artery Disease, Flecainide, Heart Failure, Hospitalization, Propafenone, Sotalol

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