Search Results for: Dronedarone

Circulation, Volume 150, Issue Suppl_1, Page A4140664-A4140664, November 12, 2024. Introduction:Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal-dominant disorder due to mutations in the FLCN gene. As an AMPK-mTOR interacting molecule, this loss-of-function mutation impacts energy homeostasis leading to uninhibited cell growth. While studies have linked this genetic mutation to severe cardiac hypertrophy, a connection to persistent atrial fibrillation (AF) is unestablished. We present a case in which an individual’s initial symptoms of AF ultimately led to a diagnosis of BHDS.Case Summary:A 56-year-old male with a history of “holiday heart syndrome” presented for an AF consultation. Despite alcohol cessation, he continued to have paroxysmal AF with severe fatigue and palpitations. After three unsuccessful cardioversions and refractory episodes despite Dronedarone therapy, he was scheduled for an ablation. A pre-procedural transesophageal echocardiogram showed a left ventricular (LV) ejection fraction of 55%, mild concentric LV hypertrophy, and mild left atrial enlargement. These enlargements were new compared with imaging one year prior. A cardiac gated CT detailed the pulmonary vein structure and incidentally revealed bilateral cystic lung changes, leading to a pulmonology referral. Despite an initial successful ablation targeting the pulmonary vein, his symptoms returned within days. He was loaded with amiodarone. Monitoring on his apple watch showed a high burden of AF. He underwent a repeat ablation to achieve complete pulmonary vein isolation with improvement in his symptoms. Further pulmonary evaluation highlighted a family history of spontaneous pneumothorax and a dermatology consultation then confirmed BHDS via fibrofolliculoma biopsy.Discussion:This case underscores the importance of comprehensive evaluations, revealing a rare genetic disorder from an initial AF assessment. While no definitive link exists between BHDS and cardiomyopathy, we aim to understand possible connections between this rare condition and its systemic cardiovascular impacts. We propose that upregulation of mTORC1 activity and attenuation of AMPK from the loss of function of FLCN lead to uncontrolled cell division and left ventricular hypertrophy. This hypertrophy then results in left atrial dilation, contributing to the development and persistence of AF. Given the rarity of this condition, more research is needed on symptom onset and systemic linkages. Swift diagnosis from incidental findings are crucial for managing symptoms and the underlying disease.

Circulation, Volume 148, Issue Suppl_1, Page A14263-A14263, November 6, 2023. Introduction:The differences in outcomes between catheter ablation (CA) versus antiarrhythmic drugs (AAD) for atrial fibrillation (AF) in the setting of heart failure with preserved ejection fraction (HFpEF) are not known.Hypothesis:We hypothesize that patients with AF and HFpEF who undergo CA will have lower morality, stroke/TIA, and acute HF compared to those treated with AAD.Methods:TriNetX, a national retrospective electronic database, was used to identify patients aged 18-80 years with AF and HFpEF from 2017-2023. Patients with a prior diagnosis of systolic HF or cross overs from AAD to CA were excluded. Patients who underwent CA were compared to those treated with AAD (amiodarone, flecainide, dronedarone, dofetilide, propafenone, sotalol). Baseline group comparison was performed using student’s t-test. Age, sex, chronic kidney disease, COPD, hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and stroke/TIA were used for 1:1 propensity matching. Kaplan Meier curves were calculated to compare all-cause mortality, stroke/TIA, acute diastolic and systolic HF.Results:Patients who received CA (n=1468) and AAD (n=7426) were propensity matched yielding 1008 patients per cohort. Compared to AAD, CA demonstrated significantly lower all-cause mortality (9.13% vs. 23.7%; HR=2.6; 95% CI [2.038,3.315]; log-rank p

Circulation, Volume 148, Issue Suppl_1, Page A15388-A15388, November 6, 2023. Introduction:Efficacy of rhythm control treatments for atrial fibrillation (AF) is usually measured by time to recurrent AF, however reduction in AF burden is a more clinically relevant endpoint. Cardiac implantable electronic devices (CIEDs) provide continuous rhythm monitoring that allows for highly accurate measures of AF burden. Ablation has been shown to reduce AF burden by > 99% in CIED patients, but there are limited data on the impact of antiarrhythmic drug (AAD) therapy on AF burden.Methods:A single-center retrospective study of all CIED patients with new AAD initiation for AF between 4/2018-3/2022 was conducted. Patients with CIED-detected AF burden within 6 months pre- and 12 months post-AAD initiation were eligible for inclusion. CIED-detected AF burden was compared pre- and post-AAD initiation.Results:Of the 214 patients included in analysis (73.6 ± 11.8 yrs, 63% male, CHA2DS2-VASc 3.8 ± 1.6), there was a statistically significant reduction in AF burden following AAD initiation (pre-AAD 4.5% [IQR: 1.0%, 27.9%]; post-AAD 0.1% [IQR: 0%, 3.2%], p

Circulation, Volume 148, Issue Suppl_1, Page A12194-A12194, November 6, 2023. Introduction:We previously reported that a computational modeling-guided antiarrhythmic drug (AAD) test was feasible for assessing diverse AADs in patients with atrial fibrillation (AF). In this study, we took the virtual AAD test (V-AAD) in patients who took AADs after AF catheter ablation (AFCA).Hypothesis:Patients using an effective drug in the VAAD test will have fewer AF recurrences than patients using an ineffective drug.Methods:This single-center retrospective study included 246 patients (72.8% male, 60.7±10.2 years of age, 38.6% paroxysmal AF) prescribed AADs within 3 months after AFCA. Using realistic computational modeling, we evaluated the effects of five AADs (amiodarone, sotalol, dronedarone, flecainide, and propafenone; 2 doses for each drug). Clinical AADs (C-AAD) were chosen at the discretion of the physicians blinded to the V-AAD test. We defined the effective V-AAD as the V-AAD that terminated AF or converted AF to atrial tachycardia (AT) and the best V-AAD as the V-AAD that ended virtual AF the fastest. We compared AF recurrence rates after the AAD prescription depending on the results of the V-AAD test.Results:The ineffective and best V-AAD were administered in 64 (26.0 %) and 70 patients (28.5%). The recurrence rate within a year after using the ineffective, effective, and best V-AAD were 46.9%, 35.7%, and 25.7%, respectively (log-rank p=0.013). The recurrence rate within a year in patients with at least one V-AAD terminating AF and those without was 33.9% and 50.0%, respectively (log-rank p=0.034). The use of best V-AAD (OR 0.43, 95% CI [0.18-0.96]; p=0.042, vs. ineffective V-AAD) is an independent predictor of AF recurrence within a year of using AAD after AFCA.Conclusions:The digital twins-guided V-AAD test was feasible for evaluating the efficacy of multiple AADs in patients with AF who had a high chance of recurrence after AFCA. We need a prospective randomization study to assess the prediction power of the V-AAD test.

Circulation, Volume 146, Issue Suppl_1, Page A15002-A15002, November 8, 2022. Introduction:Catheter ablation is used increasingly as a 1st-line (1L) alternative to antiarrhythmic drugs (AAD) including dronedarone in patients with atrial fibrillation (AF). Healthcare resource utilization (HCRU)-related costs with dronedarone vs 1L ablation are unknown.Methods:We conducted a retrospective, observational cohort study using Optum Clinformatics Data Mart® from Jan 2012-Jan 2022 among US adults with AF and no prior rhythm control therapy who received new AAD therapy with dronedarone (index: date of incident dronedarone fill) vs those who received 1L ablation, or a non-dronedarone AAD followed by ablation within 3 mo (index: date of first recorded ablation or AAD). Patients were required to have ≥24 mo of pre-index data, and ≥3 mo follow-up. Patients in the 1L ablation cohort were propensity score matched 2:1 to the dronedarone cohort. Mean payer costs per patient per month (PPPM) during the 24-mo post-index period were calculated for total HCRU, inpatient visits, emergency room (ER) visits, outpatient physicians’ office visits, and all outpatient visits, and compared by zero-inflated negative binomial (ZINB) regression model.Results:Post-matching, the dronedarone (n=1440) and 1L ablation (n=2253) cohorts had similar baseline characteristics (mean age at index: 68.4 vs 67.7 years; male: 57.7% vs 59.3%; mean time from AF diagnosis to index: 80.2 vs 91.6 days; Charlson comorbidity index: 2.3 vs 2.2; CHADS2-VASc score: 3.4 vs 3.2). Mean PPPM costs were lower with dronedarone vs 1L ablation for all-cause total HCRU, inpatient visits, any outpatient visit, ER visit, and outpatient office visit (Table). ZINB analyses showed significant cost differences for all-cause total HCRU and any outpatient visit events.Conclusion:In patients with AF and no prior rhythm control therapy, 1L dronedarone was associated with lower total HCRU and outpatient visit costs during 24-mo follow-up vs 1L ablation; future studies will assess cost-effectiveness.

Circulation, Volume 146, Issue Suppl_1, Page A13385-A13385, November 8, 2022. Introduction:The long-term effects of catheter ablation (CA) compared to medical therapy on cardiovascular outcomes for atrial fibrillation (AF) remain undetermined. We examined the outcomes associated with CA compared to rate or rhythm control therapy in a population cohort with AF.Methods:Using Alberta administrative data, patients with AF as the primary diagnosis during hospitalization or emergency department/physician visit were included between 2008-2018. Based on therapy received, patients were assigned to CA, rate (digoxin, calcium channel or beta blocker) or rhythm control (amiodarone, sotalol, flecainide, propafenone, dronedarone). If treatment changed over time, the patient was censored in the prior treatment arm and assigned to the new arm. The association of treatment (included as time-varying covariate) with the primary composite outcome of death, hospitalization for heart failure or stroke was examined using multivariable Cox models after adjusting for age, sex, comorbidities and baseline medications. Secondary outcomes included cardiovascular hospitalizations, and individual components of the composite.Results:There were 2,149 (4.0%) patients treated with CA and 51,315 with medical treatment (rate : 41,948, (81.5%) rhythm: 9,367 (18.2%). During a median follow-up of 4.2 years, CA for AF was associated with a lower crude incidence of the composite outcome (rate per 100 person-years was 3.3 for CA, 9.5 for rate control, and 6.3 for rhythm control). In multivariate analysis, compared to CA, both rate (adjusted hazard ratio (aHR) 1.55, 95% confidence interval (CI), 1.44 to 1.68) and rhythm control (aHR 1.37; 95% CI 1.27 to 1.49) were associated with a higher risk of the primary composite outcome.(Figure) Secondary outcomes are shown in the Figure.Conclusions:Only a small percentage of patients with AF undergo CA. Patients selected for CA have a lower risk of long-term adverse outcomes compared to medical therapy in patients with AF.

Circulation, Volume 146, Issue Suppl_1, Page A12148-A12148, November 8, 2022. Introduction:Atrial fibrillation is the most common disorder of cardiac rhythm, which is often associated with a high risk of morbidity and mortality. Antiarrhythmic medications (AAMs) continue to be the mainstay in the treatment of paroxysmal atrial fibrillation. However, the use of these medications has been limited by their modest anti-arrhythmic efficacy.Hypothesis:We hypothesized that dual AAMs (sodium/potassium channels blockers) improve the chance of maintaining sinus rhythm and decrease the need for catheter ablation when compared to single AAM.Methods:We conducted a retrospective observational study; we reviewed medical records of 150 patients with paroxysmal atrial fibrillation over five years at our hospital in New York. We collected the following data: age, sex, comorbidities, electrocardiogram findings, ejection fraction by echocardiography, classes of AAMs, duration and response to treatments. A successful response was defined as the absence of symptoms and the presence of sinus rhythm on electrocardiogram. A failed response was defined as persistence of symptoms and/or atrial fibrillation on electrocardiogram and the subsequent need for catheter ablation.Results:86 patients met the inclusion criteria in our analysis. The average age of the patinets was 71.06 years. 45 patients were given the dual AAMs of either amiodarone+flecainide or dronedarone+flecainide, and were treated for an average of 15.4 months. 41 patients received a single AAM then catheter ablation if needed. A chi-square test was performed. X2=18.9429, p

Circulation, Volume 146, Issue Suppl_1, Page A13500-A13500, November 8, 2022. Introduction:Dronedarone has shown clinical benefit vs sotalol in adults with atrial fibrillation (AF) post-ablation, but healthcare resource utilization (HCRU) in this setting is unknown.Methods:A retrospective, observational cohort study was conducted using IBM MarketScan® data (Jan 2012-Mar 2020) in adults with AF receiving dronedarone or sotalol post-ablation. Patients needed to have 12 months of pre-ablation data; follow-up ended at earliest of health-plan disenrollment, death or end of study (Dec 2020). Prevalence (events per 100 patient-years [PY]) was calculated for all-cause and cardiovascular (CV)-related HCRU (hospitalizations; emergency room [ER] visits; outpatient office visits; other outpatient services). Patients receiving sotalol were propensity score (PS)-matched 1:1 to patients receiving dronedarone and compared by univariate generalized linear models with Poisson distribution. Time-to-event (TTE) cumulative incidences for all-cause, CV-related and atrial tachyarrhythmia (ATA)-/AF-related hospitalization, and for pacemaker insertion, were compared by Kaplan-Meier analysis and log rank test.Results:After PS-matching, the dronedarone and sotalol (n=1600 per cohort) cohorts were successfully matched across several criteria (mean follow-up: ~28 months; age at ablation: ~61 years; proportion male: ~70%; hypertension: ~71%; heart failure: ~13%; mean CHA2DS2-VASc score: ~1.8; mean Charlson comorbidity index: ~0.8). Post-ablation, prevalence per 100 PY of all-cause hospitalization (24.0 vs 27.4), ER visits (53.1 vs 59.5) and other outpatient services (1140.1 vs 1184.5), and of CV-related hospitalization (8.4 vs 11.3), ER visits (8.5 vs 10.0) and outpatient office visits (379.6 vs 390.9), were significantly lower with dronedarone vs sotalol. Cumulative incidences were significantly lower with dronedarone vs sotalol (Figure).Conclusions:Post-ablation dronedarone was associated with lower HCRU vs sotalol.

Circulation, Volume 146, Issue Suppl_1, Page A13528-A13528, November 8, 2022. Introduction:Patterns of anti-arrhythmic drug therapy for atrial fibrillation (AF) treatment and outcomes may differ by sex. Dronedarone has shown clinical benefit vs sotalol post-ablation in males and females with AF; however, the impact of these drugs on healthcare resource utilization (HCRU) remains unknown among sex subgroups.Methods:We conducted two retrospective, observational cohort analyses using IBM MarketScan® data (Jan 2012-Mar 2020) in adult male and female patients with AF who received dronedarone or sotalol post-ablation. Patients were required to have had 12 months’ available pre-ablation data; follow-up ended at the earliest of health-plan disenrollment, death or end of data availability (Dec 2020). Prevalence (per 100 patient-years [PY]) during the post-ablation period was calculated for all-cause HCRU (hospitalizations; emergency room [ER] visits; outpatient office visits; other outpatient services). Patients receiving sotalol were propensity score matched 1:1 to patients receiving dronedarone and outcomes were compared using univariate generalized linear models with Poisson distribution.Results:In females (n=460 per cohort ; age at ablation: ~64 years; mean follow-up: ~29 months; prior heart failure: ~14.6%; mean Charlson comorbidity index [CCI]: ~0.8), post-ablation prevalence of ER visits, outpatient office visits, and other outpatient services were significantly lower with dronedarone than sotalol (Table). In males (n=1112 per cohort; age at ablation: ~60 years; mean follow-up: ~29 months; prior heart failure: ~12%; mean CCI: ~0.8), post-ablation prevalence of hospitalizations was significantly lower with dronedarone than sotalol, but other HCRU measures were similar.Conclusions:In females post-AF ablation, dronedarone was generally associated with lower HCRU than sotalol. In males, dronedarone was associated with lower hospitalization prevalence than sotalol, but other HCRU was similar.