Background Atrial fibrillation (AF) is one of the most common clinically significant cardiac arrhythmias. The management of AF includes conversion to sinus rhythm (SR). Vernakalant is a multi-channel blocker that has effectively converted recent-onset AF and has been well tolerated in placebo-controlled studies.

Purpose To assess the efficacy and safety of vernakalant hydrochloride for the pharmacological conversion of AF to SR.

Material and methods A retrospective study was conducted in the Emergency Department (ED), including all patients receiving treatment with vernakalant between 2012 and 2016. Variables included in the analysis were: age, sex, comorbidities, type of AF, progression time of AF, cardioversion effectiveness, serious and minor side-effects, average stay in ED and recurrence rate.

Results Forty-three patients with a diagnosis of recent-onset AF treated with vernakalant were included. Mean age was 68.8±11.9 years: 51.2% were females. The most common comorbidities were: arterial hypertension (65.1%), diabetes (27.9%), previous acute myocardial infarction (11.6%), valvulopathy (7%) and previous stroke (7%). 65.1% of the patients had paroxysmal AF, and 34.9% first diagnosed AF. Progression time of AF was less than 12 hours in 79.1% of patients, less than 24 hours in 4.7% and in 24 to 48 hours in 16.3% of patients. Cardioversion of AF to SR using vernakalant was effective in 37 patients (86%). Twenty-nine patients (67.4%) converted directly after the first dose, but eight patients (18.6%) required a second dose. In six patients (14%) vernakalant was ineffective. In relation to side-effects, 11.6% of patients presented tachycardia, 7% hypotension, 4.7% flutter during infusion, 2.3% sneezing and 2.3% dysgeusia. The average stay in ED was 14.3±10.9 hours, and 76.7% of patients maintained sinus rhythm.

Conclusion Vernakalant presented a high success rate in restoring SR, rapid onset of action and an acceptable safety profile. Hospital discharge was rapid after cardioversion, reducing the length of stay in the ED.

No conflict of interest