Abstract 15296: Vernakalant Shows Superiority to Ibutilide in Recent-onset Atrial Fibrillation: A Randomized Controlled Trial at the Emergency Department

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexander Simon ◽  
Jan Niederdöckl ◽  
Ekaterini Skyllouriotis ◽  
Nikola Schütz ◽  
Christoph Weiser ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Tertiary Care ◽  
Care Hospital ◽  
Recent Onset ◽  
Randomized Controlled ◽  
Conversion Rates ◽  
Onset Atrial Fibrillation

Introduction: Ibutilide is a rapid-acting antiarrhythmic drug with worldwide use for conversion of recent-onset atrial fibrillation. Vernakalant is a novel drug, which is likewise used intravenously, with proven effectiveness and safety compared to placebo and amiodarone in randomized clinical trials. Hypothesis: We hypothesized that the time to sinus rhythm and the conversion rate within 90 minutes is different between vernakalant and ibutilide in patients with recent-onset atrial fibrillation. Methods: A randomized, controlled, open-label trial registered at clinicaltrials.gov (NCT01447862) was performed in one hundred patients with recent-onset atrial fibrillation treated at the emergency department of a tertiary care hospital. Patients received up to two short-infusions of vernakalant (n= 49; 3mg/kg, 2mg/kg) or ibutilide (n= 51; 1mg, 1mg) according to the manufacturer’s instructions. Clinical and laboratory variables, adverse events, conversion rates and time to conversion were recorded. Results: Time to conversion of AF to sinus rhythm was significantly shorter in the vernakalant group compared to the ibutilide group (median time: 10min vs. 26min, p=0.02), and likewise the conversion success within 90 minutes was significantly higher (69% vs. 43%, p=0.01) in the vernakalant group. In both groups no serious adverse events occurred. Conclusion: Vernakalant was significantly faster and more effective in converting recent-onset atrial fibrillation to sinus rhythm at the emergency department.

Pharmacologic cardioversion of recent-onset atrial fibrillation: a systematic review and network meta-analysis

EP Europace ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 854-869 ◽  
Author(s):  
Ian S deSouza ◽  
Mina Tadrous ◽  
Theresa Sexton ◽  
Roshanak Benabbas ◽  
Guy Carmelli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Sinus Rhythm ◽  
English Language ◽  
Human Subjects ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Placebo Control ◽  
Recent Onset ◽  
Onset Atrial Fibrillation

Abstract Aims We sought to identify the most effective antidysrhythmic drug for pharmacologic cardioversion of recent-onset atrial fibrillation (AF). Methods and results We searched MEDLINE, Embase, and Web of Science from inception to March 2019, limited to human subjects and English language. We also searched for unpublished data. We limited studies to randomized controlled trials that enrolled adult patients with AF ≤ 48 h and compared antidysrhythmic agents, placebo, or control. We determined these outcomes prior to data extraction: (i) rate of conversion to sinus rhythm within 24 h, (ii) time to cardioversion to sinus rhythm, (iii) rate of significant adverse events, and (iv) rate of thromboembolism within 30 days. We extracted data according to PRISMA-NMA and appraised selected trials using the Cochrane review handbook. The systematic review initially identified 640 studies; 30 met inclusion criteria. Twenty-one trials that randomized 2785 patients provided efficacy data for the conversion rate outcome. Bayesian network meta-analysis using a random-effects model demonstrated that ranolazine + amiodarone intravenous (IV) [odds ratio (OR) 39.8, 95% credible interval (CrI) 8.3–203.1], vernakalant (OR 22.9, 95% CrI 3.7–146.3), flecainide (OR 16.9, 95% CrI 4.1–73.3), amiodarone oral (OR 10.2, 95% CrI 3.1–36.0), ibutilide (OR 7.9, 95% CrI 1.2–52.5), amiodarone IV (OR 5.4, 95% CrI 2.1–14.6), and propafenone (OR 4.1, 95% CrI 1.7–10.5) were associated with significantly increased likelihood of conversion within 24 h when compared to placebo/control. Overall quality was low, and the network exhibited inconsistency. Probabilistic analysis ranked vernakalant and flecainide high and propafenone and amiodarone IV low. Conclusion For pharmacologic cardioversion of recent-onset AF within 24 h, there is insufficient evidence to determine which treatment is superior. Vernakalant and flecainide may be relatively more efficacious agents. Propafenone and IV amiodarone may be relatively less efficacious. Further high-quality study is necessary.

Conversion of recent onset atrial fibrillation to sinus rhythm using a single oral loading dose of propafenone: comparison of two regimens

1997 ◽  
Vol 58 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Giovanni Luca Botto ◽  
Alessandro Capucci ◽  
Walter Bonini ◽  
Giuseppe Boriani ◽  
Tiziana Broffoni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Loading Dose ◽  
Recent Onset ◽  
Onset Atrial Fibrillation

Effect of selective beta-blockade with bisoprolol in the treatment of recent-onset atrial fibrillation

Folia Medica ◽  
2012 ◽  
Vol 54 (2) ◽  
pp. 27-31 ◽  
Author(s):  
Maria N. Negreva ◽  
Atanas P. Penev
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Combined Therapy ◽  
Beta Blockade ◽  
Recent Onset ◽  
Number Of Patients ◽  
Group A ◽  
Clinically Significant ◽  
Group B ◽  
Onset Atrial Fibrillation

ABSTRACT The incidence of atrial fibrillation has been rapidly increasing in recent years. The increased tonus of the sympathetic nervous system is related to the development of atrial fibrillation. OBJECTIVE: To study the effect of bisoprolol, a highly selective beta-blocker, on patients with recent-onset atrial fibrillation (< 48 hours) for regularization of the rhythm using propafenone. PATIENTS AND METHODS: The study includes 164 patients (81 women, 83 men, age 59.09 ± 10.81) with successfully restored sinus rhythm in recent-onset atrial fibrillation. The patients received either propafenone (group A, n = 82) or a combination of propafenone and bisoprolol (group B, n = 82). The studied patients were randomly allocated to the groups. Propafenone was administered intravenously as a 2 mg/kg bolus followed by infusion of 0.0078 mg/kg/min for 120 min and orally in dosage of 300 mg three times every 8 hours if arrhythmia persisted. Bisoprolol was administered in a single dose at the very beginning of propafenone treatment and only in patients from group B at a dose of 5 or 10 mg. Regularization of the rhythm was assessed at the 3rd, 6th, 12th and 24th hour. RESULTS: In the initial stages of regularization the combined therapy restored the sinus rhythm in a greater number of patients in comparison with the monotherapy (at the 6th hour 67.07% in group B versus 48.78% in group A, P < 0.05; at the 12th hour it was 87.80% versus 75.60%, respectively, P < 0.05). CONCLUSION: Early regularization of rhythm in patients with recent-onset atrial fibrillation reduces the likelihood of recurrent episodes of arrhythmia. This makes the application of selective beta-blockade clinically significant.

The Role of Amiodarone in Recent-Onset Atrial Fibrillation after Ibutilide Has Failed to Restore Sinus Rhythm

Cardiology ◽  
2007 ◽  
Vol 107 (4) ◽  
pp. 399-401 ◽  
Author(s):  
S. Sideris ◽  
M. Bonios ◽  
C. Melexopoulou ◽  
P. Exarchos ◽  
K. Tsatiris ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Recent Onset ◽  
Onset Atrial Fibrillation
Sign in / Sign up

Export Citation Format

Share Document