Interview with Professor John Camm at Boston Atrial Fibrillation Symposium 2010
Junuary 22, 2010 4:15 AM CT
In this video from Boston Atrial Fibrillation Symposium 2010, Professor John Camm discusses the two newest antiarrhythmic drugs, dronedarone (Multaq®), which is now approved in the US and Europe for atrial fibrillation, and vernakalant, which is a year or two away. These antiarrhythmic (rhythm control) drugs help to put patients back into normal sinus rhythm, or to keep them in it.
John Camm is Professor of Clinical Cardiology at St. George’s University of London in the UK.
View the video of Prof. Camm at Boston Atrial Fibrillation Symposium 2010:
Mellanie True Hills: This is Mellanie True Hills of StopAfib.org. I’m at the Boston Atrial Fibrillation Symposium 2010, and with me is Professor John Camm. He is the Professor of Clinical Cardiology at St. George’s University of London. I’m thrilled to have an opportunity to chat with him about some of the things that are really exciting and on the forefront in atrial fibrillation. He’s agreed to share with us about some of the exciting things happening in antiarrhythmic drugs. So, thank you Professor Camm for joining us today.
Professor John Camm: Thank you, Mellanie. As you said, I’m going to talk to you a little bit about new antiarrhythmic drugs. I’m sure most of you who are looking at this know what an antiarrhythmic drug is—it is an agent which is used to try and prevent atrial fibrillation, or to delay its recurrence, or to shorten its duration. So, classic antiarrhythmic drugs are agents like, for example, quinidine, or propafenone, or sotalol. Well, it must be no surprise to you that since some of these agents are not very effective, we’re on the lookout for new compounds.
Fortunately, we’ve recently had released a new agent, which is called dronedarone. Its trade name is Multaqâ. Now, dronedarone is a compound that was developed from amiodarone. It shares some similarities with that drug, but importantly, it doesn’t have iodine in the molecule, so it doesn’t cause any thyroid problems, and it also has a side-chain on the molecule that makes it not soluble in fat. So for that reason, it doesn’t get in the liver, and it doesn’t get in the lungs, and you don’t have all of those side effects, which amiodarone has. But quite apart from it being an anti-arrhythmic drug without many side effects, importantly, it has a very substantial efficacy, not necessarily at just suppressing the arrhythmia, it also controls the heart rate if the arrhythmia occurs, and it has a small effect on blood pressure. All of these are very useful effects.
There was a very important study during the development of this drug, which was called ATHENA, in which patients who entered the study were treated either with dronedarone or placebo in what is called a “blinded fashion”, and then followed for an average of 21 months. As it turned out, the patients who received dronedarone did so much better than those who got the placebo tablet. In particular, there was a dramatic reduction in the frequency with which patients had to go into the hospital, and the number of hospital days was dramatically reduced. There was also a reduction in cardiovascular mortality, which of course is very important to anybody who has atrial fibrillation. And so this drug is obviously a very important newcomer. And as you know, it’s approved and it’s on the market here in the United States, and increasingly in other parts of the world.
Now, following on from that drug, there are yet other new important antiarrhythmic drugs, and one that will not take long to get to the United States is called vernakalant. Now, vernakalant is a drug which is used as an intravenous preparation. You receive a dose intravenously if you have an attack of atrial fibrillation that is not going away, and this drug converts the atrial fibrillation to so-called “normal sinus rhythm.” All that happens is that you have two ten-minute infusions of this drug. It has very few side effects. It causes a little drop in blood pressure, particularly in patients who have a poor heart, but in most patients with relatively good hearts there is hardly any side effect problem with the drug. If the atrial fibrillation is caught in time, let’s say within 24 or 48 hours after it first started, the drug is highly effective in terminating the arrhythmia. Something like 70–75% of cases will go back to normal sinus rhythm with practically no risk associated with the infusion of the drug. Very good news.
Now, after that, there are lots more drugs on the drawing board, but none of them are yet near the clinic for clinical use. Some are just getting used in patients in an exploratory fashion, but it will be at least five years before we have any of the other drugs. So, for now, dronedarone, a great new antiarrhythmic drug to consider, and vernakalant, in perhaps a year or two from now.
MTH: Ok, great. Professor Camm, thank you so much for joining us and sharing with us information about new antiarrhythmic drugs. For StopAfib.org, this is Mellanie True Hills. Thank you.
Disclaimer: The maker of dronedarone (Multaq®) is one of our many StopAfib.org sponsors. Our policy is to be balanced in our coverage and to avoid favoring sponsors, and thus sponsors’ products must be especially noteworthy to be covered.