Abstract
AimsRapid restoration of sinus rhythm using pharmacological cardioversion is commonly indicated in patients with symptomatic recent-onset atrial fibrillation (AF). The objectives of this large, international, multicenter observational study were to determine the safety and effectiveness of intravenous (IV) vernakalant for conversion of AF to sinus rhythm in daily practice.Methods and ResultsConsenting patients with symptomatic recent-onset AF (< 7 days) treated with IV vernakalant were enrolled and followed up to 24 h after the last infusion or until discharge, in order to determine the incidence of predefined serious adverse events (SAEs) and other observed SAEs and evaluate the conversion rate within the first 90 min. Overall, 2009 treatment episodes in 1778 patients were analyzed. The age of patients was 62.3 ± 13.0 years (mean ± standard deviation). Median AF duration before treatment was 11.1 h (IQR 5.4–27.0 h). A total of 28 SAEs occurred in 26 patients including 19 predefined SAEs, i.e., sinus arrest (n = 4, 0.2%), significant bradycardia (n = 11, 0.5%), significant hypotension (n = 2, 0.1%), and atrial flutter with 1:1 conduction (n = 2, 0.1%). There were no cases of sustained ventricular arrhythmias or deaths. All patients who experienced SAEs recovered fully (n = 25) or with sequelae (n = 1). Conversion rate to sinus rhythm was 70.2%, within a median of 12 min (IQR 8.0–28.0 min).ConclusionsThis large multicenter, international observational study confirms the good safety profile and the high effectiveness of vernakalant for the rapid cardioversion of recent-onset AF in daily hospital practice.
Highlights
Introduction and Purpose of the StudyAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated 33.5 million people affected worldwide [1]
The majority of patients were treated in the emergency departments (EDs) for 1289 (64.1%) AF episodes and 563 (28.0%) AF episodes in the coronary or intensive care units, with the remainder 157 (7.8%) episodes being treated in other hospital settings
In 1905 (94.7%) AF episodes, vernakalant was administered to non-surgery patients, and in 104 (5.2%) to post-cardiac surgery patients
Summary
Introduction and Purpose of the StudyAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated 33.5 million people affected worldwide [1]. Patients with AF are at increased risk of stroke and heart failure [3, 4]. A significant number of patients with recent-onset AF seen in the emergency departments (EDs) undergo commonly in Europe pharmacological cardioversion. Vernakalant is a partial atrial-selective antiarrhythmic agent by its action through IKur and IKACh channel inhibition [5]. It has a modest effect on the ventricle via Ina and IKr channels resulting in a limited effect on ventricular repolarization (QT interval) [5]. Vernakalant is contraindicated in patients with prolonged QT interval
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