Dronedarone for atrial fibrillation: a new therapeutic agent

Pawan D Patel, Rohit Bhuriya, Dipal D Patel, Bhaskar L Arora, Param P Singh, Rohit R AroraDepartment of Cardiology, Chicago Medical School, Chicago, IL, USAAbstract: Atrial fibrillation is the most common of the serious cardiac rhythm disturbances and is responsible for substantial morbidity and mortality. Amiodarone is currently one of the most widely used and most effective antiarrhythmic agents for atrial fibrillation. But during chronic usage amiodarone can cause some serious extra cardiac adverse effects, including effects on the thyroid. Dronedarone is a newer therapeutic agent with a structural resemblance to amiodarone, with two molecular changes, and with a better side effect profile. Dronedarone is a multichannel blocker and, like amiodarone, possesses both a rhythm and a rate control property in atrial fibrillation. The US Food and Drug Administration approved dronedarone for atrial fibrillation on July 2, 2009. In this review, we discuss the role of dronedarone in atrial fibrillation.Keywords: dronedarone, amiodarone, atrial fibrillatio

Zotarolimus-eluting stent versus sirolimus-eluting and paclitaxel-eluting stents for percutaneous coronary intervention: A meta-analysis of randomized trials

SummaryBackgroundThe zotarolimus-eluting stent (ZES) is a new drug-eluting stent that delivers zotarolimus, a synthetic analogue of sirolimus, through a biocompatible phosphorylcholine polymer coating. ZES has shown promising results compared with bare-metal stents, but its safety and efficacy against sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents is yet to be established.AimsWe aimed to summarize current evidence from randomized trials comparing ZES with SES and PES.MethodsWe searched the Medline, Embase and CENTRAL databases for randomized studies comparing ZES with SES and PES for percutaneous coronary intervention. Relevant clinical and angiographic outcomes were extracted and combined using random and fixed-effect models for heterogeneous and homogenous outcomes, respectively.ResultsSeven randomized trials met the inclusion criteria: ZES group, n=3787; SES group, n=2606; PES group, n=1966. Compared with SES, ZES was associated with significantly higher odds of clinically driven target vessel revascularization (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.78–3.14) and target lesion revascularization (OR 2.46, 95% CI 1.36–4.46). Compared with SES, ZES had higher in-stent restenosis (OR 6.13, 95% CI 3.96–9.50), late lumen loss ‘in-stent’ (mean difference [MD] 0.39mm, 95% CI 0.34–0.44) and late lumen loss ‘in-segment’ (MD 0.18mm, 95% CI 0.15–0.21). ZES was associated with higher in-stent late lumen loss than PES (MD 0.18mm, 95% CI 0.07–0.28). There were no differences in mortality, reinfarction or stent thrombosis with ZES compared with SES and PES.ConclusionZES is not superior to PES and is inferior to SES in terms of angiographic outcomes and clinically driven revascularization