Intravenous vernakalant for the rapid conversion of recent onset atrial fibrillation: systematic review and meta-analysis

Abstract

Atrial fibrillation is the most common cardiac arrhythmia and is associated with increased mortality and morbidity. Conversion to sinus rhythm is usually appropriate in patients with acute, symptomatic atrial fibrillation in order to reduce symptoms and prevent complications. Electrical cardioversion is the most used and widespread technique, but requires deep sedation and a fasting state. Pharmacological alternatives are burdened by a delayed onset of action and potential proarrhythmic effects. Therefore, new therapeutic options are being sought. Among those, vernakalant, showed a good efficacy profile and a short onset of action, but with conflicting evidence regarding potential serious adverse events. This drug profile will summarize the pharmacology behind this new drug and review recent evidence in terms of safety and efficacy.

Effect of Antazoline on Electrophysiological Properties of Atrial Muscle and Conduction System of the Heart

“…Thus, inhibition of parasympathetic ganglia may play an important role in quick AF cessation. Among antiarrhythmic drugs, only the recently approved vernakalant is comparably fast in sinus rhythm restoration [ 17 , 18 ]. Other commonly used agents usually require hours to achieve AF termination.…”

Cardioversion of recent-onset atrial fibrillation: current evidence, practical considerations, and controversies in a complex clinical scenario

“…Dysgeusia, sneezing and paresthesia are the most common side effects. Hypotension and conversion of AF into 1:1 AV conduction AFL are rarer but serious potential side effects [101]. In many setting, the cost of vernakalant, as compared to other options, constitutes a potential limitation to its standard use.…”

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

“…Vernakalant is usually a well-tolerated drug and most common side effects include paresthesia, dysgeusia, dizziness, sneezing, and nausea and these effects are probably related to the inhibition of the sodium channels in the central nervous system; also most of these side effects are mild and transient. 38 Of note, de Riva-Silva et al 39 reported a case of 1:1 AV conduction atrial flutter after Vernakalant administration for AF conversion; however, Guerra et al 38 reported that no cases of significant arrhythmia or hemodynamic dysfunction are generally observed when cautions and contraindications are respected.…”