Dronedarone versus amiodarone for preventing atrial fibrillation recurrence after catheter ablation: A GRADE-assessed meta-analysis of reconstructed time-to-event data with trial sequential analysis

Authors

• Ahmed Emara, Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Ahmed Mansour, Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Belal Mohamed Hamed, Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Ahmed Elbataa, Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Ahmed Adel Azim, Department of Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
• Mohamed Hamouda Elkasaby, Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
• Ameer Awashra, Department of Medicine, An-Najah National University, Nablus, Palestine.
• Abdalhakim Shubietah, Advocate Health - MidwestFollow
• Ali Bin Jabbar, Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, NE.
• Anan Abu Rmilah, Department of Medicine, University of Iowa, Iowa City, IA.
• Giuseppe Andò, Department of Clinical and Experimental Medicine, University of Messina and Azienda Ospedaliera Papardo, Viale Ferdinando Stagno d'Alcontres, Messina, Italy.
• Islam Y. Elgendy, Department of Medicine, Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY.
• William H. Frishman, Departments of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY.
• Wilbert S. Aronow, Departments of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY.

Recommended Citation

Emara A, Mansour A, Hamed BM, et al. Dronedarone Versus Amiodarone for Preventing Atrial Fibrillation Recurrence After Catheter Ablation: A GRADE-Assessed Meta-Analysis of Reconstructed Time-to-Event Data With Trial Sequential Analysis. Cardiol Rev. Published online September 1, 2026. doi:10.1097/CRD.0000000000001452

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Atrial fibrillation (AF) recurrence remains a major challenge after catheter ablation, and whether dronedarone or amiodarone should be preferred during the post-ablation blanking period is unresolved. We performed a systematic review and meta-analysis comparing these 2 agents after AF catheter ablation. Five single-center Chinese studies (1 open-label randomized trial and 4 retrospective cohorts) enrolling 996 patients (507 dronedarone and 489 amiodarone) were included. In reconstructed individual patient data from 4 studies, AF recurrence did not differ between dronedarone and amiodarone (hazard ratio [HR] 1.06; 95% confidence interval [CI], 0.75-1.50; P = 0.746), confirmed by a 30-day landmark analysis (HR 1.08; 95% CI, 0.75-1.56; P = 0.690), by study-level pooling of HRs (HR 1.06; 95% CI, 0.74-1.52; I2 = 0%), and by restricted mean survival time analysis. Recurrence also did not differ during the blanking period (risk ratio [RR] 1.09; 95% CI, 0.85-1.40) or over long-term follow-up (RR 1.17; 95% CI, 0.89-1.55). Dronedarone was associated with lower risks of QTc-interval prolongation (RR 0.39; 95% CI, 0.19-0.80) and thyroid dysfunction (RR 0.37; 95% CI, 0.24-0.57) but higher risks of gastrointestinal (RR 7.72; 95% CI, 2.10-28.37) and dermatologic (RR 4.20; 95% CI, 1.06-16.53) adverse events. Dronedarone and amiodarone appear equally effective at preventing AF recurrence after catheter ablation but differ in safety, so selection should be individualized according to patient-specific tolerability and toxicity risk.

Type

Article

PubMed ID

42679308