Dronedarone: Una reale innovazione o solo una valida seconda scelta? Come districarsi tra linee guida, agenzie regolatorie e pratica clinica quotidiana

Dronedarone is the antiarrhythmic drug with the most complete and wide literature
preceding its marketing. Most of these studies showed a good efficacy along with
an excellent risk profile, especially in low- and medium-risk patients. Recently,
updates of European, American and even Italian guidelines gave dronedarone its
own spot into the antiarrhythmic armamentarium, recommending its use both for
rhythm control and rate control in non-permanent atrial fibrillation. In Italy,
however, dronedarone prescription is still possible only when amiodarone is not
tolerated, making dronedarone a mere second choice of its older "relative".
Moreover, patients taking dronedarone must undergo a strict alanine
aminotransferase and bilirubin follow-up, which usefulness in predicting
drug-induced liver damage (probably idiosyncratic in nature and therefore
unpredictable) is far from demonstrated. The aim of this review is to sum up
actual evidences on dronedarone, describe how these evidences had been
differently transposed by panel of experts and drug agencies into guidelines and
recommendations, and define the current difficulties encountered by the
cardiologist in the correct use of this new antiarrhythmic agent in clinical
practic