Vernakalant for recent onset AF

Vernakalant for recent onset AF

Vernakalant for recent onset AF: Vernakalant is a rapidly acting drug useful in the treatment of recent onset atrial fibrillation. Unlike amiodarone which is a slow acting drug, vernakalant is a rapidly acting medication. Both intravenous and oral preparations have been tried. It is an atrial selective agent with actions on Kv1.5 channel conducting IKur current and Kir3.1/3.4 channel which conducts IKAch current. It has actions on Ito (transient outward current), late sodium current and mild effect on the rapid component of the delayed rectifying current IKr. Side effects listed include bad taste, paraesthesia, sneezing, nausea and rarely hypotension and very rarely ventricular arrhythmias [1]. Long term studies documenting efficacy and safety may be needed further.

2016 European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation give Class I, level A recommendation for pharmacological cardioversion of AF with no history of ischemic heart disease or structural heart disease [2]. In those with stable ischemic heart disease or moderate heart failure or abnormal LVH, it is Class IIb, level B.

References

1. David Tian, William H Frishman. Vernakalant: a new drug to treat patients with acute onset atrial fibrillation. Cardiol Rev. Jan-Feb 2011;19(1):41-4.
2. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-2962.