Impact of Dronedarone on Early Recurrence After Catheter Ablation in Patients With Nonparoxysmal Atrial Fibrillation

This study is aimed at comparing the efficacy and safety of dronedarone, amiodarone, and propafenone in preventing early recurrence of atrial arrhythmias during the blanking period following catheter ablation in patients with nonparoxysmal atrial fibrillation.

We retrospectively analyzed 408 patients with nonparoxysmal atrial fibrillation who underwent their first catheter ablation. Patients were divided into three groups based on the postoperative antiarrhythmic drug prescribed: dronedarone, amiodarone, or propafenone. A propensity score matching (PSM) analysis was performed as the primary analysis to compare early recurrence rates and drug-related adverse events. An inverse probability of treatment weighting (IPW) analysis was conducted as a sensitivity analysis.

Of the 408 patients, 65 (15.9%) experienced early recurrence. The early recurrence rate was significantly lower in the dronedarone group (9.2%) compared to propafenone (27.2%), but not significantly different from amiodarone (14.0%). The dronedarone group showed a lower recurrence rate of atrial flutter compared to both the propafenone and amiodarone groups (p < 0.05). After PSM, the recurrence rate of atrial flutter remained significantly lower in the dronedarone group compared to propafenone and amiodarone. Regarding drug-related adverse events, 73 patients (17.9%) experienced adverse reactions, with the amiodarone group showing a significantly higher incidence (24.2%) compared to the propafenone (13.6%) and dronedarone (11.8%) groups.

In this retrospective study of patients with nonparoxysmal atrial fibrillation after catheter ablation, dronedarone and amiodarone showed a trend toward better efficacy than propafenone in preventing overall early recurrence. Dronedarone demonstrated a specific advantage in preventing early recurrence of atrial flutter.