scholarly journals Vernakalant in Atrial Fibrillation: A Relatively New Weapon in the Armamentarium Against an Old Enemy

2019 ◽  
Vol 13 ◽  
pp. 117739281986111 ◽  
Author(s):  
Antoine Kossaify
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Structural Heart Disease ◽  
Rhythm Control ◽  
Disease Class ◽  
Recent Onset ◽  
Comprehensive Management ◽  
Class Iib ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

Atrial fibrillation is the most common sustained cardiac arrhythmia, and its prevalence is increasing with age; also it is associated with significant morbidity and mortality. Rhythm control is advised in recent-onset atrial fibrillation, and in highly symptomatic patients, also in young and active individuals. Moreover, rhythm control is associated with lower incidence of progression to permanent atrial fibrillation. Vernakalant is a relatively new anti-arrhythmic drug that showed efficacy and safety in recent-onset atrial fibrillation. Vernakalant is indicated in atrial fibrillation (⩽7 days) in patients with no heart disease (class I, level A) or in patients with mild or moderate structural heart disease (class IIb, level B). Moreover, Vernakalant may be considered for recent-onset atrial fibrillation (⩽3 days) post cardiac surgery (class IIb, level B). Although it is mainly indicated in patients with recent-onset atrial fibrillation and with no structural heart disease, it can be given in moderate stable cardiac disease as alternative to Amiodarone. Similarly to electrical cardioversion, pharmacological cardioversion requires a minimal evaluation and cardioversion should be included in a comprehensive management strategy for better outcome.

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 Usefulness of electrocardiography in the differential diagnosis of dyspnoea

2015 ◽  
Vol 5 (2S) ◽  
pp. 21-25
Author(s):  
Flavio Cerrato ◽  
Angelo Bosio ◽  
Claudio Pascale
Keyword(s):  
Atrial Fibrillation ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
Rhythm Control ◽  
Prolonged Qt Interval ◽  
Prolonged Qt ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation ◽  
New Onset ◽  
Severe Dyspnoea

We report a case of a 88-year-old female, admitted to the hospital with tachycardia, chest pain and dyspnoea. ECG revelead a recent new-onset atrial fibrillation. A pharmacological cardioversion with amiodarone was performed, and restoration of sinus rhythm was obtained. Sotalol for rhythm control was administered. On the eighth day after the admission, she presented with severe dyspnoea and hypotension. An ECG revelead torsade de pointes, associated with prolonged QT interval. Several factors are involved in determining dyspnoea. ECG, although not specific, is an important instrument that supports clinicians in assessment of dyspnoea.

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.

scholarly journals Rapid pharmacological cardioversion of recent-onset atrial fibrillation using antazoline in elderly patients

2021 ◽  
Author(s):  
Michał M. Farkowski ◽  
Aleksander Maciąg ◽  
Małgorzata Żurawska ◽  
Karol Kołakowski ◽  
Piotr Gardziejczyk ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Recent Onset ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation
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