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Spotlight on Intravenous Vernakalant in Recent-Onset Atrial Fibrillation

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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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Acknowledgements and Disclosures

The full text article[24] from which this spotlight was derived was 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.

The manufacturer of the agent under review was offered an opportunity to comment on the original article[24] during the peer review process; changes based on any comments received were made on the basis of scientific and editorial merit. The preparation of the original article and this spotlight was not supported by an external funding.

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  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

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  1. Sean T. Duggan
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Correspondence to Sean T. Duggan.

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Adapted and reproduced from Drugs 2010; 71 (2): 237–252.

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Duggan, S.T., Scott, L.J. Spotlight on Intravenous Vernakalant in Recent-Onset Atrial Fibrillation. Drugs Aging 28, 501–504 (2011). https://doi.org/10.2165/11207060-000000000-00000

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