Dronedarone (Multaq) for the treatment of atrial fibrillation

Atrial fibrillation (AF) is a major public health problem and its complications lead to increased hospitalizations, mortality and healthcare costs [1,2]. Advanced age (>75 years), history of prior stroke or transient ischemic attack (TIA), presence of diabetes mellitus, hypertension, cardiac failure and vascular disease are all associated with nonvalvular AF patients and the risk of c omplications, such as stroke [3,4]. There is evidence indicating that rhythm and rate control strategies may have a similar impact on cardiovascular outcomes and life expectancy in AF patients. The results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study indicated that management of AF with the rhythm-control strategy offers no survival advantage over the rate-control strategy; indeed, a rate-control strategy has potential advantages including decreased risk of adverse drug effects [5,6]. The lack of reliable antiarrhythmic drugs with proven efficacy, safety and tolerability is another reason for rate control strategy. Whilst amiodarone is still the most effective drug for the rhythm control strategy in AF patients [7], a safer (but probably less effective) alternative to amiodarone, dronedarone (Multaq, Sanofi Aventis, Surrey, UK) has been developed and assessed in clinical trials. In this article we aim to discuss dronedarone’s advantages and disadvantages and its implementation to daily therapeutic practice in AF patients.