Dronedarone in atrial fibrillation: the aftermath of the PALLAS trial.

Dronedarone is a new antiarrhythmic currently approved for use among patients with nonpermanent atrial fibrillation (AF) based on the positive results of the ATHENA trial. Dronedarone was recently investigated in the PALLAS (Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy) trial, a landmark trial that evaluated treatment with dronedarone compared with placebo among older patients with permanent AF. The trial was terminated early due to a significant increase in adverse cardiovascular events among dronedarone-treated patients. In this article, the trial is presented and the significance and practical implications of the results in the management of older patients with AF briefly discussed.