scholarly journals P304A real-world comparison of vernakalant efficacy and safety for pharmacological cardioversion in patients with recent-onset atrial fibrillation in an emergency department and after cardiac surgery

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii48-iii48
Author(s):  
J. Osca Asensi ◽  
MJ. Ferre ◽  
MJ. Perez-Dura ◽  
R. Vicente ◽  
P. Alonso ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cardiac Surgery ◽  
Real World ◽  
Efficacy And Safety ◽  
Recent Onset ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

scholarly journals Intravenous vernakalant in comparison with intravenous flecainide in the cardioversion of recent-onset atrial fibrillation

2017 ◽  
Vol 8 (2) ◽  
pp. 114-120 ◽  
Author(s):  
Hanna Pohjantähti-Maaroos ◽  
Harri Hyppölä ◽  
Maria Lekkala ◽  
Emma Sinisalo ◽  
Antti Heikkola ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Female Gender ◽  
Efficacy And Safety ◽  
Single Centre ◽  
Recent Onset ◽  
The Difference ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

Background: Pharmacological cardioversion of atrial fibrillation is a reasonable alternative for electrical cardioversion in acute atrial fibrillation. We compared the efficacy and safety of intravenous vernakalant and intravenous flecainide in patients with recent-onset (< 48 h) atrial fibrillation. Methods: A total of 200 consecutive patients, 100 patients undergoing cardioversion with intravenous vernakalant and 100 patients undergoing cardioversion with intravenous flecainide, were included in this single centre non-randomized retrospective study. The primary endpoint was conversion to sinus rhythm within 120 minutes from the drug administration. Results: Cardioversion was successful in 67% of patients treated with vernakalant and in 46% of patients treated with flecainide ( p=0.003). Vernakalant (odds ratio 1.99, 95% confidence interval 1.08–3.69, p=0.029) and female gender (odds ratio 2.48, 95% confidence interval 1.22–15.05, p=0.012) were significant predictors of successful cardioversion. The success rate of cardioversion was lowest among men treated with flecainide (36.9%). Patients treated with vernakalant were discharged earlier from the emergency department compared with those treated with flecainide (8.2 ± 4.7 h vs. 12.0 ± 6.0 h, p < 0.001). There was no difference in the complication rate between the groups. Vernakalant treated patients were older (59.3 ± 12.5 vs. 55.4 ± 13.0 years, p=0.03), had higher CHA2DS2-VASc score (1.4 ± 1.3 vs. 0.9 ± 1.2, p = 0.002) and were more often on beta-blocker medication (59% vs. 42%, p= 0.016) than flecainide treated patients. Conclusion: Vernakalant was safe, more effective and faster than flecainide in the cardioversion of recent-onset atrial fibrillation. The difference in efficacy was especially apparent among men.

scholarly journals Vernakalant for Rapid Cardioversion of Recent-Onset Atrial Fibrillation: Results from the SPECTRUM Study

2020 ◽  
Author(s):  
Samuel Lévy ◽  
Juha Hartikainen ◽  
Beate Ritz ◽  
Tord Juhlin ◽  
José Carbajosa-Dalmau ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Observational Study ◽  
Sinus Rhythm ◽  
Conversion Rate ◽  
Daily Practice ◽  
Serious Adverse Events ◽  
Multicenter Observational Study ◽  
Recent Onset ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

Abstract Aims Rapid 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 Results Consenting 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). Conclusions This 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.

scholarly journals Cardioversion of recent-onset atrial fibrillation using intravenous antiarrhythmics

2021 ◽  
Author(s):  
Samuel Levy
Keyword(s):  
Atrial Fibrillation ◽  
Real Life ◽  
Torsades De Pointes ◽  
Antiarrhythmic Agents ◽  
Success Rates ◽  
Class Iii ◽  
Recent Onset ◽  
New Class ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

ABSTRACT (195 words) Pharmacological cardioversion using intravenous antiarrhythmic agents is commonly indicated in symptomatic patients with recent-onset atrial fibrillation (AF). Except in hemodynamically unstable patients who require emergency direct current electrical cardioversion, for the majority of hemodynamically stable patients, pharmacological cardioversion represents a valid option and requires the clinician to be familiar with the properties and use of antiarrhythmic agents. The main characteristics of selected intravenous antiarrhythmic agents for conversion of recent-onset AF, the reported success rates and possible adverse events are discussed. Among intravenous antiarrhythmics, flecainide, propafenone, amiodarone, sotalol, dofetilide, ibutilide and vernakalant are commonly used. Antazoline, an old antihistaminic agent with antiarrhythmic properties was also reported to give encouraging results. Intravenous flecainide and propafenone are the only class I agents still recommended by recent guidelines. Intravenous new class III agents as dofetilide and ibutilide have high and rapid efficacy in converting AF to sinus rhythm but require strict surveillance with ECG monitoring during and after intravenous administration because the potential risk of QT prolongation and Torsades de Pointes which can be prevented and properly managed. Vernakalant, a partial atrial selective was shown to have a high success rate and to be safe in real life use.

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