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Objectif: Déterminer si l’efficacité de l’amiodarone pour le maintien du rythme sinusal varie selon la fonction systolique ventriculaire gauche. Contexte: Malgré un profil de sécurité établi en insuffisance cardiaque, nous ignorons si l’efficacité de l’amiodarone et son impact sur différentes issues cardiovasculaires sont modulés par la fonction ventriculaire gauche. Méthode: Nous avons effectué une analyse combinée de 3307 patients (âgés de 68,0±0,9 ans ; 31,1% de femmes) recrutés dans les études AFFIRM et AF-CHF qui ont été randomisés au contrôle du rythme par l’amiodarone (N=1107) ou au contrôle de la fréquence cardiaque (N=2200). Résultats: Chez les patients sous amiodarone, la survie sans fibrillation auriculaire était de 84% et de 45% à 1 et 5 ans respectivement, sans égard à la fraction d’éjection ventriculaire gauche (P=0,8754, ajusté). De façon similaire, la proportion moyenne ajustée de temps en fibrillation auriculaire (15,0±1,8%) n’a pas été influencée par la fraction d’éjection (P=0,6094). Durant le suivi, 1963 patients (59,4%) ont requis au moins une hospitalisation, incluant 1401 (42,6%) patients hospitalisés pour cause cardiovasculaire. Les taux ajustés d’hospitalisation pour toutes causes et pour cause cardiovasculaire étaient similaires entre les patients sous amiodarone et ceux dans le groupe de contrôle de la fréquence dans l’ensemble de la population ainsi que dans les sous-groupes de patients avec et sans dysfonction ventriculaire gauche sévère. De façon similaire, les taux ajustés de mortalité globale et cardiovasculaire étaient similaires entre chez les patients sous amiodarone et ceux traités par le contrôle de la fréquence dans l’ensemble de la population ainsi que dans les sous-groupes de patients avec et sans dysfonction ventriculaire gauche sévère. Conclusions: L’efficacité de l’amiodarone pour le maintien du rythme sinusal n’est pas influencée par la fonction ventriculaire gauche. Le contrôle du rythme avec l’amiodarone s’associe à des taux de mortalité et d’hospitalisation comparables au contrôle de la fréquence à la fois chez les patients avec et sans dysfonction ventriculaire gauche sévère. / Objectives: To determine whether amiodarone’s efficacy in maintaining sinus rhythm varies according to left ventricular systolic function. Background: Despite amiodarone’s established safety profile in heart failure, it is unknown whether its impact on cardiovascular outcomes is modulated by ventricular function. Methods: We conducted a pooled analysis of 3307 patients (age 68.0±0.9 years; 31.1% female) enrolled in AFFIRM and AF-CHF trials who were randomized to rhythm control with amiodarone (N=1107) or rate control (N=2200). Results: In amiodarone-treated patients, freedom from recurrent atrial fibrillation was 84% and 45% at 1 and 5 years, respectively, with no differences according to left ventricular function (adjusted P=0.8754). Similarly, the adjusted mean proportion of time in atrial fibrillation (15.0±1.8%) did not vary according to ventricular function (P=0.6094). During follow-up, 1963 (59.4%) patients required at least one hospitalization, with 1401 (42.6%) patients hospitalized for a cardiovascular reason. Adjusted all-cause and cardiovascular hospitalization rates were similar with amiodarone versus rate control in the overall population and in subgroups of patients with and without severe left ventricular dysfunction. Similarly adjusted all-cause and cardiovascular mortality rates were similar with amiodarone versus rate control, overall and in subgroups of patients with and without severe left ventricular dysfunction. Conclusions: Amiodarone’s efficacy in maintaining sinus rhythm and reducing the burden of atrial fibrillation is similar in patients with and without left ventricular dysfunction. Rhythm control with amiodarone was associated with similar mortality and hospitalisation rates when compared to rate control in patients with and without severe left ventricular dysfunction.

Objectif: Déterminer si l’efficacité de l’amiodarone pour le maintien du rythme sinusal varie selon la fonction systolique ventriculaire gauche. Contexte: Malgré un profil de sécurité établi en insuffisance cardiaque, nous ignorons si l’efficacité de l’amiodarone et son impact sur différentes issues cardiovasculaires sont modulés par la fonction ventriculaire gauche. Méthode: Nous avons effectué une analyse combinée de 3307 patients (âgés de 68,0±0,9 ans ; 31,1% de femmes) recrutés dans les études AFFIRM et AF-CHF qui ont été randomisés au contrôle du rythme par l’amiodarone (N=1107) ou au contrôle de la fréquence cardiaque (N=2200). Résultats: Chez les patients sous amiodarone, la survie sans fibrillation auriculaire était de 84% et de 45% à 1 et 5 ans respectivement, sans égard à la fraction d’éjection ventriculaire gauche (P=0,8754, ajusté). De façon similaire, la proportion moyenne ajustée de temps en fibrillation auriculaire (15,0±1,8%) n’a pas été influencée par la fraction d’éjection (P=0,6094). Durant le suivi, 1963 patients (59,4%) ont requis au moins une hospitalisation, incluant 1401 (42,6%) patients hospitalisés pour cause cardiovasculaire. Les taux ajustés d’hospitalisation pour toutes causes et pour cause cardiovasculaire étaient similaires entre les patients sous amiodarone et ceux dans le groupe de contrôle de la fréquence dans l’ensemble de la population ainsi que dans les sous-groupes de patients avec et sans dysfonction ventriculaire gauche sévère. De façon similaire, les taux ajustés de mortalité globale et cardiovasculaire étaient similaires entre chez les patients sous amiodarone et ceux traités par le contrôle de la fréquence dans l’ensemble de la population ainsi que dans les sous-groupes de patients avec et sans dysfonction ventriculaire gauche sévère. Conclusions: L’efficacité de l’amiodarone pour le maintien du rythme sinusal n’est pas influencée par la fonction ventriculaire gauche. Le contrôle du rythme avec l’amiodarone s’associe à des taux de mortalité et d’hospitalisation comparables au contrôle de la fréquence à la fois chez les patients avec et sans dysfonction ventriculaire gauche sévère. / Objectives: To determine whether amiodarone’s efficacy in maintaining sinus rhythm varies according to left ventricular systolic function. Background: Despite amiodarone’s established safety profile in heart failure, it is unknown whether its impact on cardiovascular outcomes is modulated by ventricular function. Methods: We conducted a pooled analysis of 3307 patients (age 68.0±0.9 years; 31.1% female) enrolled in AFFIRM and AF-CHF trials who were randomized to rhythm control with amiodarone (N=1107) or rate control (N=2200). Results: In amiodarone-treated patients, freedom from recurrent atrial fibrillation was 84% and 45% at 1 and 5 years, respectively, with no differences according to left ventricular function (adjusted P=0.8754). Similarly, the adjusted mean proportion of time in atrial fibrillation (15.0±1.8%) did not vary according to ventricular function (P=0.6094). During follow-up, 1963 (59.4%) patients required at least one hospitalization, with 1401 (42.6%) patients hospitalized for a cardiovascular reason. Adjusted all-cause and cardiovascular hospitalization rates were similar with amiodarone versus rate control in the overall population and in subgroups of patients with and without severe left ventricular dysfunction. Similarly adjusted all-cause and cardiovascular mortality rates were similar with amiodarone versus rate control, overall and in subgroups of patients with and without severe left ventricular dysfunction. Conclusions: Amiodarone’s efficacy in maintaining sinus rhythm and reducing the burden of atrial fibrillation is similar in patients with and without left ventricular dysfunction. Rhythm control with amiodarone was associated with similar mortality and hospitalisation rates when compared to rate control in patients with and without severe left ventricular dysfunction.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Dronedarone is a new antiarrhythmic agent and amiodarone analogue developed to reduce the toxic effects related to amiodarone. Dronedarone was approved for the maintenance of the sinus rhythmic in adult patients with atrial fibrillation and to reduce the risk of hospitalization in these patients. It is commercially available as film-coated tablets. There are no official monographs in any pharmacopoeia or analytical methods described in the literature for the analysis of dronedarone in pharmaceutical dosage form or bulk form. In the present study, an analytical methodology was developed for the analysis of dronedarone in pharmaceutical dosage form and bulk form. The reversed-phase liquid chromatography method was performed using a Waters XBridge C18 column (250 mm × 4.6 mm). The mobile phase consisted of buffer solution pH 4.9 / acetonitrile (35:65, v/v), running at a flow rate of 1.0 mL/min, using photodiode array detector set at 289 nm. The chromatographic separation was obtained within 7.0 min and it was linear in the concentration range from 5.0 to 100.0 μg/mL (r = 0.9999). The spectrophotometric method was developed and validated and dronedarone was quantified at 289 nm, using methanol as diluent. The micellar electrokinetic method was also developed and validated, using nimesulide as internal standard. The analyses were performed on a fused-silica capillary (50 μm i.d.; effective length, 40 cm), using electrolyte solution consisted of 40 mm borate buffer and 50 mM SDS at pH 9.2, with detection by photodiode array detector set at 216 nm. The injection was performed using the hydrodynamic mode at 50 mbar for 7 s and a constant voltage of 28 kV was applied during analysis. The electrophoretic separation was obtained within 7.0 min and it was linear in the concentration range from 25 to 150 μg/mL (r = 0.9995). The procedures were validated evaluating parameters such as the specificity, linearity, precision, accuracy, limits of detection and quantitation and robustness, giving results within the acceptable range. The proposed methods were applied for the analysis of the pharmaceutical product, showing significant correlation between the results (p > 0.05). The spectrophotometric method was developed and validated using acetate buffer pH 4.5 as diluent and UV detection at 289 nm, which was applied to evaluate the dissolution test. The dissolution test was developed using 900 mL of acetate buffer pH 4.5 at 37°C, as dissolution medium, and paddle as apparatus at a stirring rate of 75 rpm. / A dronedarona é um novo agente antiarrítmico análogo à amiodarona, desenvolvido com o propósito de reduzir os efeitos adversos relacionados à amiodarona. Foi aprovado para a manutenção do ritmo cardíaco normal em pacientes com fibrilação atrial e, assim, reduzir os riscos de hospitalização. Comercialmente, encontra-se disponível na forma farmacêutica de comprimidos revestidos. Não há monografias descritas em farmacopeias ou métodos na literatura para análise de dronedarona em forma farmacêutica ou matéria-prima. No presente trabalho, foi desenvolvida metodologia para a avaliação de dronedarona em forma farmacêutica e matéria-prima. O método por cromatografia líquida em fase reversa foi realizado utilizando-se coluna Waters XBridge C18 (250 mm × 4,6 mm). A fase móvel foi composta por solução tampão pH 4,9 / acetonitrila (35:65, v/v) eluída no fluxo de 1,0 mL/min e detecção no ultravioleta em 289 nm. A separação cromatográfica foi obtida no tempo de 7,0 min, sendo linear na faixa de concentração de 5-100 μg/mL (r = 0,9999). Paralelamente, desenvolveu-se e validou-se método por espectrofotometria no ultravioleta em 289 nm utilizando metanol como diluente. Também foi desenvolvido e validado método por cromatografia eletrocinética micelar utilizando nimesulida como padrão interno. As análises foram realizadas em capilar de sílica fundida (comprimento efetivo de 40 cm e diâmetro de 50 μm), mantido a 30°C, utilizando solução eletrolítica composta de tampão borato 40 mM e SDS 50 mM, pH 9,2, com detecção no ultravioleta em 216 nm. A injeção foi realizada no modo hidrodinâmico a 50 mbar durante 7 s e voltagem constante de 28 kV foi aplicada durante as análises. A separação eletroforética foi obtida em 7,0 min, sendo linear na faixa de 25-150 μg/mL (r = 0,9995). Os procedimentos foram validados considerando-se os parâmetros especificidade, linearidade, precisão, exatidão, limite de detecção e quantificação e robustez, cujos resultados cumpriram os requisitos preconizados. Os métodos propostos foram aplicados na análise quantitativa de produtos farmacêuticos, demonstrando correlação significativa dos resultados (p > 0,05). Desenvolveu-se e validou-se método por espectrofotometria no UV utilizando tampão acetato pH 4,5 como diluente e detecção em 289 nm, o qual foi aplicado para avaliar a percentagem dissolvida dos comprimidos de dronedarona. O método de dissolução foi desenvolvido utilizando como meio 900 mL de tampão acetato pH 4,5 mantido a 37°C, aparato pá e rotação de 75 rpm.