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Intravenous Vernakalant

A Review of its Use in the Management of Recent-Onset Atrial Fibrillation

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An Erratum to this article was published on 01 February 2011

Abstract

Intravenous vernakalant (Brinavess®) is an atrial-repolarization-delaying agent that is currently approved in the EU for the rapid conversion of recent-onset atrial fibrillation to sinus rhythm. Vernakalant blocks atrial-specific potassium and sodium ion channels, prolonging atrial refractory periods and rate-dependently slowing atrial conduction, without promoting ventricular arrhythmia.

In pivotal randomized, phase III trials, intravenous vernakalant 3 mg/kg administered as a 10-minute infusion, followed by a 2 mg/kg 10-minute infusion after 15 minutes if atrial fibrillation persisted, was effective in the rapid termination of recent-onset atrial fibrillation in nonsurgical patients (≥3 hours’ to ≤7 days’ duration) and in those with postoperative atrial fibrillation (3–72 hours’ duration) following cardiac surgery. Conversion to sinus rhythm occurred rapidly following infusion of vernakalant, with the majority of patients converting after the first dose, and conversion to sinus rhythm was generally associated with a rapid resolution of symptoms. These antiarrhythmic effects of vernakalant were durable, with most responders remaining in sinus rhythm 24 hours after treatment initiation. In nonsurgical patients with recent-onset atrial fibrillation of 3–48 hours’ duration, vernakalant was more effective than intravenous amiodarone, with a significantly higher proportion of patients converting to sinus rhythm within the first 90 minutes of treatment. Vernakalant was generally well tolerated in clinical trials, with most adverse events being of mild or moderate severity and not treatment limiting. Increases in QRS or QT intervals were transient, and there was no increased incidence of ventricular arrhythmia observed with vernakalant compared with placebo. Therefore, intravenous vernakalant provides an effective option for the management of recent-onset atrial fibrillation.

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Author information

Authors and Affiliations

  1. Adis, a Wolters Kluwer Business, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand

    Sean T. Duggan & Lesley J. Scott

Authors
  1. Sean T. Duggan
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  2. Lesley J. Scott
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Corresponding author

Correspondence to Sean T. Duggan.

Additional information

Various sections of the manuscript reviewed by: D. Atar, Division of Cardiology, University of Oslo, Oslo, Norway; M. Banach, Department of Hypertension, Medical University of Lodz, Lodz, Poland; J.R. Ehrlich, Division of Cardiology, Goethe-Universität, Frankfurt, Germany; D. Fedida, Department of Anesthesiology, Pharmacology and Therapeutics and Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada; G.Y.H. Lip, Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK; I. Savelieva, Division of Cardiac and Vascular Sciences, St George’s University of London, London, UK.

Data Selection

Sources: Medical literature (including published and unpublished data) on ‘vernakalant’ was identified by searching databases since 1996 (including MEDLINE, EMBASE and AdisBase), bibliographies from published literature, clinical trial registries/databases and websites (including those of regional regulatory agencies and the manufacturer). Additional information (including contributory unpublished data) was also requested from the company developing the drug.

Search strategy: MEDLINE, EMBASE and AdisBase search terms were ‘vernakalant’, ‘atrial fibrillation’. Searches were last updated on 11 January 2010.

Selection: Studies in patients with recent-onset atrial fibrillation who received vernakalant. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic and pharmacokinetic data are also included.

Index terms: Vernakalant, atrial fibrillation, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability.

An Erratum for this chapter can be found at http://dx.doi.org/0012-6667/11/0003-0381/$55.55/0

Various sections of the manuscript reviewed by: D. Atar, Division of Cardiology, University of Oslo, Oslo, Norway; M. Banach, Department of Hypertension, Medical University of Lodz, Lodz, Poland; J.R. Ehrlich, Division of Cardiology, Goethe-Universität, Frankfurt, Germany; D. Fedida, Department of Anesthesiology, Pharmacology and Therapeutics and Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada; G.Y.H. Lip, Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK; I. Savelieva, Division of Cardiac and Vascular Sciences, St George’s University of London, London, UK.

An erratum to this article is available at http://dx.doi.org/10.2165/11585420-000000000-00000.

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Duggan, S.T., Scott, L.J. Intravenous Vernakalant. Drugs 71, 237–252 (2011). https://doi.org/10.2165/10489050-000000000-00000

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