Arrhythmias & electrophysiology
Dronedarone vs Sotalol Among Patients With Atrial Fibrillation: A Meta-Analysis of Retrospective Observational Databases
Authors' conclusion
In this retrospective meta-analysis, dronedarone exhibited significantly lower rates of CV hospitalization and ventricular arrhythmias compared with sotalol. These findings provide real-world evidence to support selection of the most appropriate first-line AAD for rhythm control in patients with AF.
Study context
- Population
- AAD-naive patients with Atrial Fibrillation (AF), from Optum Clinformatics Data Mart, Merative MarketScan, Veterans Health Administration Electronic Health Record, and the Swedish National Patient Register4 retrospective observational cohort studies from 4 databases
- Comparison
- Dronedarone vs sotalol
- Outcome
- Primary outcomes, tested hierarchically: Cardiovascular (CV) hospitalization, then ventricular arrhythmias
Methodological detailsone master protocol, target trial emulation, active comparator, new user design, as-treated approach, propensity score matching, negative control outcomes, fixed effects models
- One master protocol
- Target trial emulation
- Active comparator, new user design
- As-treated approach
- Propensity score matching
- Negative control outcomes
- Fixed effects models
Pooled result
As reported in the abstract
dronedarone vs sotalolPooled hazard ratio (95% CI)
CV hospitalization
0.91(0.85–0.97)
Ventricular arrhythmias
0.77(0.69–0.85)
Further pooled results
Cohort balance after propensity score matching (PSM)
- Mean age range
- 62.5-70.9 years
- Mean CHA2DS2-VASc score range
- 1.81-3.15
- Well balanced within databases before and after PSM
Negative control outcomes
- Little-to-no evidence of residual confounding
Original publication
Dronedarone vs Sotalol Among Patients With Atrial Fibrillation: A Meta-Analysis of Retrospective Observational Databases. JACC Clin Electrophysiol. Published 23 April 2025. doi:10.
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