Safety and efficacy of pharmacological cardioversion of atrial fibrillation using intravenous vernakalant, a new antiarrhythmic drug with atrial selectivity.
BACKGROUND
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that due to its frequent hospitalizations and increased complication rates imposes a significant health economic burden. Many patients with recurrent AF are admitted to the hospital for cardioversion to restore sinus rhythm. Given this knowledge, it is clearly important to identify a feasible and effective approach for cardioversion of these patients. Cardioversion always requires careful assessment of potential complications, which apart from thromboembolic risks, include proarrhythmias and those related to the deep sedation required for electrical cardioversion. Even though electrical cardioversion is proven to be safe and effective, the need for anesthesia makes alternative strategies more attractive.


METHODS
The research discussed is the alternative strategies for cardioversion, including electrical cardioversion and the new relatively atrial-selective antiarrhythmic drug, vernakalant. The literature search methodology undertaken included search in PubMed (cardioversion, vernakalant, conversion as key words).


CONCLUSIONS
Vernakalant is shown to have good conversion rates, an apparently safe antiarrhythmic profile and is well tolerated in patients with a history of ischemic heart disease. In most cases of recent-onset AF, pharmacological cardioversion can provide a probably more cost-effective and safer alternative to electrical cardioversion, which can then be used as a second option for those who failed the first attempt of cardioversion.
Uppsala University, Department of Cardiology, S-75185 Uppsala, Sweden. carina.blomstrom.lundqvist@akademiska.se
Carina
C
Blomström-Lundqvist
Per
P
Blomström
D000840:Anisoles / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004562:Electrocardiography / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy; D015221:Potassium Channels / Q000187:drug effects; D011759:Pyrrolidines / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology; D015222:Sodium Channels / Q000187:drug effects
D000840:Anisoles; D000889:Anti-Arrhythmia Agents; D015221:Potassium Channels; D011759:Pyrrolidines; D015222:Sodium Channels; C524581:vernakalant