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Chemical cardioversion of recent-onset atrial fibrillation in the emergency department using vernakalant hydrochloride achieves safe and rapid restoration of sinus rhythm and facilitates same day discharge

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Abstract

Background

Vernakalant hydrochloride is a rapid-acting antiarrhythmic drug licensed in the EU since 2010 for the conversion of recent-onset atrial fibrillation with proven efficacy and safety when compared with placebo and amiodarone in randomized clinical trials.

Aims

The aim of our study was to determine the feasibility of same day discharge (following 2 h monitoring) from the emergency department after successful cardioversion using vernakalant hydrochloride.

Methods

Patients with recent-onset atrial fibrillation treated in the emergency department of a large Dublin academic teaching hospital. Patients received a maximum of two weight based 10 min infusions of vernakalant. Hypotensive events (>30% initial blood pressure), arrhythmias, conversion rates, and time to conversion were recorded.

Results

Sinus rhythm was restored in 35 out of 42 patients (83%) in an average of 8.8 min (median 8 min), average CHA2DS2-VASc of 0.92, HAS-BLED of 0.21 and average symptoms duration of 12 h. There were no hypotensive or arrhythmogenic events. 41 out of 42 patients were discharged after 2 h of monitoring.

Conclusions

Vernakalant hydrochloride has provided a quick, safe, and practical means of achieving rapid restoration of sinus rhythm in our ED population with stable recent-onset AF who would otherwise not have undergone routine electrically cardioversion and same day discharge.

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Authors and Affiliations

  1. Beaumont Hospital, Dublin, Ireland

    P. Stoneman, P. Mahon & R. Sheahan

  2. Emergency Medicine, Beaumont Hospital, Dublin, Ireland

    P. Gilligan

  3. Mechanical Engineering, Dublin City University, Dublin, Ireland

    R. Sheahan

Authors
  1. P. Stoneman
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  2. P. Gilligan
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  3. P. Mahon
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  4. R. Sheahan
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Corresponding author

Correspondence to P. Stoneman.

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Conflict of interest

Mr. Paul Stoneman declares that he has no conflict of interest. Dr. Peadar Gilligan declares that he has no conflict of interest. Mr. Paul Mahon declares that he has no conflict of interest. Dr. Richard Sheahan declares that he has received a speaker honorarium from Cardiome.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study as part of standard hospital policy.

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Stoneman, P., Gilligan, P., Mahon, P. et al. Chemical cardioversion of recent-onset atrial fibrillation in the emergency department using vernakalant hydrochloride achieves safe and rapid restoration of sinus rhythm and facilitates same day discharge. Ir J Med Sci 186, 903–908 (2017). https://doi.org/10.1007/s11845-017-1576-1

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  • DOI: https://doi.org/10.1007/s11845-017-1576-1

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