Please login or register to print this page.

News & Views

Vernakalant for the conversion of acute AF, superior to amiodarone

According to a double-blind study,[1] published recently in the Journal of the American College of Cardiology, vernakalent possesses superior efficacy to amiodarone in the conversion of atrial fibrillation (AF) to sinus rhythm (SR) for patients with acute symptomatic AF.

The authors of the AVRO study also assert that, while both treatments were found to be safe and well tolerated, vernakalant had “low proarrhythmic potential and provides a rapidly acting therapeutic alternative”.

The research team, led by Professor John Camm from St. George’s University of London, conducted a randomized, double-blind, multicenter superiority trial in 254 adult patients with underlying cardiovascular disease, making certain antiarrhythmic drugs inappropriate for use. 116 patients in each group received at least one dose of the study drug. Approximately 30% of patients in both treatment arms had no AF episodes prior to the initial diagnosis, whereas one-third had at least three.

Those in the vernakalant study arm received a 10-minute infusion of 3 mg/kg followed by an additional 10-minute infusion of 2 mg/kg if needed after a 15-minute observation period. Amiodarone patients received a 60-minute infusion of 5 mg/kg followed by an additional 60-minute maintenance infusion of 50 mg. Regarding the primary end point of the study, the proportion of patients in sinus rhythm at 90 minutes, 51.7% of patients were converted from AF to sinus rhythm in the vernakalant arm, compared with just 5.2% of those in the amiodarone arm (p<0.0001).

Treatment with vernakalant resulted in a rapid conversion to sinus rhythm, with a median conversion time of 11 minutes. For the secondary end point, 53% of patients treated with vernakalant were without AF symptoms at 90 minutes, compared with 33% of the amiodarone-treated patients. Significant improvements in quality-of-life scores were also reported among the vernakalant-treated patients.

In an accompanying editorial[2] Dr Bruce D. Lindsay observes that, despite receiving the majority support of an advisory panel in 2007, vernakalant is still awaiting approval from the Food and Drug Administration (FDA) in the US pending further safety data due to “concerns related to the risk of hypotension and usage in patients with heart failure or acute coronary syndromes”. Lindsay advises that, although positive results such as those from the AVRO study may lead to future approval, “caution should be exercised if the drug is administered to patients with more extensive heart disease or comorbidities”.

References

  1. A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation, Camm, AJ et al, J Am Coll Cardiol, 2011; 57:313 – 321
  2. Vernakalant: Additional Evidence for Safety and Efficacy for New Onset Atrial Fibrillation, Lindsay, B, J Am Coll Cardiol, 2011; 57:322 – 333

Published on: February 2, 2011

Members Area

Log in or Register now.

SEARCH THE SITE

RSS FEED

Subscribe to our RSS feed
home

GET EXCLUSIVE UPDATES

Sign up for our regular email newsletters & be the first to know about fresh articles and site updates.

RECENT COMMENTS

    None Found

ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

You are not logged in

You need to be a member to print this page.
Sign up for free membership, or log in.

You are not logged in

You need to be a member to download PDF's.
Sign up for free membership, or log in.