This study demonstrates that repeated isoflurane general anesthesia impaired psychomotor performance in aged mice during the initial learning period; however, spatial learning improved and, overall, spatial memory and psychomotor performance were unimpaired. Thus, general anesthesia alone does not appear to result in prolonged cognitive deficits in aged mice.

Our results indicate that cognitive impairments in the early recovery period after ECT are reduced with propofol compared to thiopental anesthesia. We suggest that, in addition to ECT parameters, the type of anesthetic agent should be considered to reduce cognitive impairments after ECT.

Background-Vernakalant, a relatively atrial-selective antiarrhythmic drug, has previously demonstrated efficacy for the acute conversion of atrial fibrillation (AF) to sinus rhythm. This study was designed to determine the most appropriate oral dose of vernakalant for the prevention of AF recurrence postcardioversion. Methods and Results-Patients with nonpermanent AF were randomized to 150, 300, or 500 mg vernakalant or placebo twice daily for up to 90 days. The efficacy analysis was conducted on 605 of 735 patients who entered the maintenance phase on day 3 after cardioversion. The time to the first recurrence of symptomatic sustained AF was significantly longer in the 500 mg vernakalant group, with a median of Ͼ90 days versus 29 days in the placebo group (hazard ratio, 0.735; Pϭ0.0275). No significant effect was seen at the lower doses. The percent of patients in sinus rhythm at day 90 was 41%, 39%, and 49% in the 150-mg (nϭ147), 300-mg (nϭ148), and 500-mg (nϭ150) vernakalant groups, respectively, compared with 36% in the placebo group (nϭ160). There were no vernakalant-related proarrhythmic events. Related serious adverse events occurred in 2 patients in the 150-mg vernakalant group and in 1 patient in each of the other groups. Conclusions-Vernakalant, 500 mg twice daily, appears to be effective and safe for the prevention of AF recurrence after cardioversion. The absence of proarrhythmia and favorable safety profile is an important finding for the drug. Key Words: antiarrhythmia agents Ⅲ arrhythmia Ⅲ cardioversion Ⅲ prevention Ⅲ vernakalant M aintenance of sinus rhythm is a necessary goal in many patients with paroxysmal or persistent atrial fibrillation (AF). In the Euro Heart Survey, 1 77% of patients with paroxysmal or persistent AF received pharmaceutical rhythm control therapy. Currently available antiarrhythmic drugs have important limitations. The most effective compound, amiodarone, is associated with severe noncardiac side effects. 2,3 Class 1C antiarrhythmics and sotalol are associated with risks of proarrhythmia, which limit their use. 4 Finally, the newly registered dronedarone was significantly inferior to amiodarone for the composite primary end point of time to first AF recurrence or premature study drug discontinuation (due to intolerance or lack of efficacy). 5 Thus, there is a continued need to develop safe and efficacious antiarrhythmic drugs. Clinical Perspective on p 643Vernakalant represents a novel class of antiarrhythmics being developed for conversion as well as maintenance of sinus rhythm after conversion. The electrophysiological properties differ from currently available compounds. Vernakalant has relative atrial specificity and targets early-activating and acetylcholine-activated potassium channels and has a weak effect on sodium channels in atria and ventricles. 6 -8 Vernakalant slows conduction at rapid pacing rates and prolongs atrial refractoriness. The intravenous formulation has been demonstrated to rapidly convert recent onset AF to sinus rhythm in several clinical trials...