title: Vernakalant-facilitated electrical cardioversion: comparison of intravenous vernakalant and amiodarone for drug-enhanced electrical cardioversion of atrial fibrillation after failed electrical cardioversion.
abstract: OBJECTIVE
  Electrical cardioversion is one cornerstone for the rhythm control strategy of atrial fibrillation (AF), which is, however, hampered by immediate AF recurrence (IRAF) or failed electrical cardioversion (FECV). We aimed to investigate the potential role of vernakalant for facilitated electrical cardioversion in cardioversion-resistant AF.
  
  
  RESULTS
  The subjects of this study were 63 patients referred to the Heart Centre Leipzig between November 2011 and May 2014 for transthoracic electrical cardioversion of AF. All patients experienced after antiarrhythmic-naïve electrical cardioversion either IRAF (n = 44; 70%) or FECV (n = 19; 30%). After drug infusion, electrical cardioversion was successful in 66.7% of vernakalant-treated as opposed to 46.7% of amiodarone-treated patients (P = 0.109). Multivariate analysis revealed treatment with vernakalant (OR 0.057, 95% CI 0.006-0.540, P = 0.013), treatment with ACEI or ARB (OR 0.101, 95% CI 0.015-0.691 P = 0.019), and IRAF after initial CV (OR 0.047, 95% CI 0.004-0.498, P = 0.011) as predictors for successful, drug-facilitated electrical cardioversion. Subgroup analysis of 18 patients with previous AF ablation revealed a significantly higher success rate of electrical cardioversion after infusion of vernakalant than after infusion of amiodarone (66.7 vs. 11.1%, P = 0.016).
  
  
  CONCLUSIONS
  Vernakalant may therefore be considered as a useful agent for facilitated electrical cardioversion in cardioversion-resistant AF.
authors.affiliation: Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany andreas.muessigbrodt@gmail.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Müssigbrodt
authors.affiliation: Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: John
authors.affiliation: Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
authors.forename: Jedrzej
authors.initials: J
authors.lastname: Kosiuk
authors.affiliation: Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
authors.forename: Sergio
authors.initials: S
authors.lastname: Richter
authors.affiliation: Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage*; D000840:Anisoles / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D004359:Drug Therapy, Combination / Q000379:methods; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D011759:Pyrrolidines / Q000008:administration & dosage*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000840:Anisoles; D000889:Anti-Arrhythmia Agents; D011759:Pyrrolidines; C524581:vernakalant; D000638:Amiodarone
keywords: Amiodarone; Atrial fibrillation; Electrical cardioversion; IRAF; Immediate AF recurrence; Vernakalant