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.
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.


OBJECTIVE
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.
Beaumont Hospital, Dublin, Ireland. paulstoneman@beaumont.ie.
P
P
Stoneman
Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
P
P
Gilligan
Beaumont Hospital, Dublin, Ireland.
P
P
Mahon
Beaumont Hospital, Dublin, Ireland.|Mechanical Engineering, Dublin City University, Dublin, Ireland.
R
R
Sheahan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000840:Anisoles / Q000494:pharmacology / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004554:Electric Countershock / Q000379:methods*; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D011759:Pyrrolidines / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
D000840:Anisoles; D000889:Anti-Arrhythmia Agents; D011759:Pyrrolidines; C524581:vernakalant
Acute atrial fibrillation; Atrial fibrillation; Chemical cardioversion; Emergency department; Pharmacological cardioversion; Recent onset; Same day discharge