[Preventing stroke by treating atrial fibrillation--new hope with dronedarone and dabigatran?]

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting about 1% of adults; its prevalence increases with age. Nine percent of those aged 80 years and older have AF. AF is associated with increased cardiovascular mortality and morbidity, and the risk of stroke ist increased by the factor 5. Stroke in patients with AF is more severe and more likely to be fatal. Prevention of thromboembolism with oral anticoagulants and rate- or rhythm-control are the main therapeutic strategies for patients with AF. But vitamin K antagonists, which reduce the risk of stroke in patients with AF, are underutilized. Until recently, rhythm-control studies did not show any benefit in the prevention of cardiovascular complications, including stroke. New drugs have recently become available that may add to the therapeutic options. A post-hoc analysis of dronedarone, a novel antiarrhythmic drug, suggests a reduction of the risk of stroke by 34% (p = 0.027) in patients with non-permanent atrial fibrillation in addition to standard therapy, including antithrombotics. The novel anticoagulant dabigatran showed stroke reductions and improved safety in the RE-LY trial which compared its efficacy with warfarin. On-going studies will help to identify those patients with AF who are likely to benefit from these novel antithrombotic and antiarrhythmic agents by reducing the risk of stroke.