Author + information
- Andreas Bollmann,
- Silke John,
- Andreas Muessigbrodt,
- Borislav Dinov,
- Sergio Richter and
- Gerhard Hindricks
Electrical cardioversion (ECV) may be hampered by immediate AF recurrence (IRAF) or failed electrical cardioversion (FECV) occurring in up to 15 %. Interestingly, current AF management guidelines do not specifically address management in this situation although intravenous amiodarone is considered the most potent drug for the acute management of cardioversion-resistant AF. This study tested the hypothesis that vernakalant is effective and safe in facilitating ECV of cardioversion-resistant AF.
This study included 30 consecutive antiarrhythmic-naive patients referred for transthoracic ECV of persistent AF > 7 days with either IRAF or FECV. Patients were randomized to receive an open-label infusion of either 5 mg/kg amiodarone over 10 minutes (n=15) or 3 mg/kg vernakalant over 10 minutes (n=15). Ten minutes after completion of the drug infusion, transthoracic ECV was attempted again and restoration of sinus rhythm was considered the primary study endpoint.
Drug-infusion was completed in all patients. In total, ECV was successful in 53 % after drug infusion. Clinical characteristics of patients with successful ECV were comparable to those with IRAF or FECV after drug administration. ECV was effective in 73 % after vernakalant as opposed to 33 % after amiodarone (p=0.028). Multivariable analysis revealed vernakalant use as the only independent predictor for restoration of sustained sinus rhythm (OR 0.182, 95% CI 0.038–0.873, p=0.033). There were no major adverse events. Three patients (20 %) in the vernakalant group described transient tingling paraesthesia in their upper body during drug infusion (vs. 0 % in the amiodarone group, p=0.068).
Vernakalant is effective and safe in facilitating ECV of cardioversion-resistant AF and may be superior to amiodarone. However, additional and larger studies are needed to confirm these findings.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias: Atrial Fibrillation Clinical Mechanisms
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1105M-40
- 2013 American College of Cardiology Foundation