Heart rhythm O2 · 2026
Intravenous vernakalant for acute termination of recent-onset atrial fibrillation in the emergency department.
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Heller Karin, Viskin Dana, Freund Ophir, Frydman Shir, Grinberg Sharon, Zandberg Efrat, Slieman Moaath, Zeltser David, Rosso Raphael, Viskin Sami, Chorin Ehud
Аннотация
BACKGROUND: Early conversion of recent-onset atrial fibrillation (AF) is of clinical value. Vernakalant is an atrial-selective, rapid-acting antiarrhythmic drug. We report a large cohort of consecutive patients receiving vernakalant for the conversion of AF and review the clinical trials reporting on its safety and efficacy.
OBJECTIVE: This study aimed to determine the effectiveness and safety of cardioversion of recent-onset AF with intravenous vernakalant in the emergency department.
METHODS: Retrospective observational study of adults presenting with recent-onset AF (≤48 hours) treated with intravenous vernakalant. Patients received either a simplified fixed-dose protocol (300 mg ± second dose of 200 mg) or a weight-adjusted protocol (3 mg/kg ± 2 mg/kg). The primary efficacy end point was conversion to sinus rhythm. Safety end points included all adverse events (AEs).
RESULTS: Among 328 consecutive patients treated with vernakalant (median age 61 years; 56% male), vernakalant restored sinus rhythm within minutes of administration in 268 patients (82%). First-dose conversion occurred in 68% (70% of the fixed-dose group vs 56% of the weight-adjusted-dose group; P = .015). Within a 48-hour time window, a shorter time from symptoms to treatment had a relatively low predictive ability (area under the receiver operating characteristic curve 0.61) for predicting cardioversion. AEs occurred in 34 patients (10%) but were almost invariably mild; serious AEs occurred in only 1 patient (0.3%) but involved a fatality attributable to unrecognized severe cardiomyopathy.
CONCLUSION: In an emergency department, intravenous vernakalant was highly effective for terminating recent-onset AF, rapidly converting 82% of AF episodes within minutes of drug administration.
OBJECTIVE: This study aimed to determine the effectiveness and safety of cardioversion of recent-onset AF with intravenous vernakalant in the emergency department.
METHODS: Retrospective observational study of adults presenting with recent-onset AF (≤48 hours) treated with intravenous vernakalant. Patients received either a simplified fixed-dose protocol (300 mg ± second dose of 200 mg) or a weight-adjusted protocol (3 mg/kg ± 2 mg/kg). The primary efficacy end point was conversion to sinus rhythm. Safety end points included all adverse events (AEs).
RESULTS: Among 328 consecutive patients treated with vernakalant (median age 61 years; 56% male), vernakalant restored sinus rhythm within minutes of administration in 268 patients (82%). First-dose conversion occurred in 68% (70% of the fixed-dose group vs 56% of the weight-adjusted-dose group; P = .015). Within a 48-hour time window, a shorter time from symptoms to treatment had a relatively low predictive ability (area under the receiver operating characteristic curve 0.61) for predicting cardioversion. AEs occurred in 34 patients (10%) but were almost invariably mild; serious AEs occurred in only 1 patient (0.3%) but involved a fatality attributable to unrecognized severe cardiomyopathy.
CONCLUSION: In an emergency department, intravenous vernakalant was highly effective for terminating recent-onset AF, rapidly converting 82% of AF episodes within minutes of drug administration.