Intravenous
vernakalant (Brinavess®) is an atrial-repolarization-delaying agent that is currently approved in the EU for the rapid conversion of recent-onset
atrial fibrillation to sinus rhythm.
Vernakalant blocks atrial-specific
potassium and
sodium ion channels, prolonging atrial refractory periods and rate-dependently slowing atrial conduction, without promoting ventricular
arrhythmia. In pivotal, randomized, phase III trials, intravenous
vernakalant 3 mg /kg administered as a 10-minute infusion, followed by a 2 mg/kg 10-minute infusion after 15 minutes if
atrial fibrillation persisted, was effective in the rapid termination of recent-onset
atrial fibrillation in nonsurgical patients (≥ 3 hours' to ≤ 7 days' duration) and in those with postoperative
atrial fibrillation (3-72 hours' duration) following cardiac surgery. Conversion to sinus rhythm occurred rapidly following infusion of
vernakalant, with the majority of patients converting after the first dose, and conversion to sinus rhythm was generally associated with a rapid resolution of symptoms. These antiarrhythmic effects of
vernakalant were durable, with most responders remaining in sinus rhythm 24 hours
after treatment initiation. In nonsurgical patients with recent-onset
atrial fibrillation of 3-48 hours' duration,
vernakalant was more effective than intravenous
amiodarone, with a significantly higher proportion of patients converting to sinus rhythm within the first 90 minutes of treatment.
Vernakalant was generally well tolerated in clinical trials, with most adverse events being of mild or moderate severity and not treatment limiting. Increases in QRS or QT intervals were transient, and there was no increased incidence of ventricular
arrhythmia observed with
vernakalant compared with placebo. Therefore, intravenous
vernakalant provides an effective option for the management of recent-onset
atrial fibrillation.