Intravenous vernakalant for acute termination of recent-onset atrial fibrillation in the emergency department.

Background: Early conversion of recent-onset atrial fibrillation (AF) is of clinical value. Vernakalant is an atrial-selective, rapid-acting antiarrhythmic drug. We report a large cohort of consecutive patients receiving vernakalant for the conversion of AF and review the clinical trials reporting on its safety and efficacy. Objective: This study aimed to determine the effectiveness and safety of cardioversion of recent-onset AF with intravenous vernakalant in the emergency department. Methods: Retrospective observational study of adults presenting with recent-onset AF (≤48 hours) treated with intravenous vernakalant. Patients received either a simplified fixed-dose protocol (300 mg ± second dose of 200 mg) or a weight-adjusted protocol (3 mg/kg ± 2 mg/kg). The primary efficacy end point was conversion to sinus rhythm. Safety end points included all adverse events (AEs). Results: Among 328 consecutive patients treated with vernakalant (median age 61 years; 56% male), vernakalant restored sinus rhythm within minutes of administration in 268 patients (82%). First-dose conversion occurred in 68% (70% of the fixed-dose group vs 56% of the weight-adjusted-dose group; Conclusion: In an emergency department, intravenous vernakalant was highly effective for terminating recent-onset AF, rapidly converting 82% of AF episodes within minutes of drug administration.