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Dronedarone Contraindications — EECC MCQ

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ModerateCardiac PharmacologyDronedarone ContraindicationsEECC

A 50-year-old man with paroxysmal AF is started on dronedarone 400 mg twice daily for rhythm control. He has no structural heart disease and LVEF is 58%. Six months later, he develops permanent AF. What should be done with dronedarone?

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Correct answer: A — Stop dronedarone — it is contraindicated in permanent AF due to increased cardiovascular events demonstrated in the PALLAS trial

Dronedarone (a non-iodinated benzofuran derivative of amiodarone) is indicated for rhythm control in paroxysmal or persistent AF in patients without HFrEF or permanent AF. The PALLAS trial was terminated early because dronedarone in permanent AF significantly increased cardiovascular death, stroke, and HF hospitalisation. The 2024 ESC AF Guidelines contraindicate dronedarone in: (1) permanent AF, (2) HFrEF (LVEF <40%), (3) NYHA III-IV HF, and (4) hepatic impairment. In the ATHENA trial, dronedarone reduced the composite of hospitalisation and death in non-permanent AF without severe HF. When AF becomes permanent, dronedarone must be stopped and replaced with rate control agents.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation; PALLAS Trial