Contemporary Approach to Electrical and Pharmacological Cardioversion of Atrial Fibrillation

Rajagopalan, Bharath; Curtis, Anne B.

doi:10.3810/pgm.2012.11.2610

Cited by 7 publications

(3 citation statements)

References 88 publications

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“…While other agents are recommended for pharmacological cardioversion by the European Society of Cardiology, their use is often limited by the delayed onset of action and side effects [6,31]. A randomized phase 3 study has shown that in patients with recent-onset AF, Cardiology 2022;147:566-577 DOI: 10.1159/000526831 vernakalant was superior to the widely used amiodarone in terms of cardioversion rate (51.7 vs. 5.2% within 90 min) [24].…”

Section: Discussionmentioning

confidence: 99%

Vernakalant for Cardioversion of Recent-Onset Atrial Fibrillation in the Emergency Department: The SPECTRUM Study

Bager¹,

Martı́n²,

Dalmau³

et al. 2022

Cardiology

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Introduction: Intravenous vernakalant is a therapeutic option for symptomatic, recent-onset atrial fibrillation (AF). This secondary analysis from the large SPECTRUM study assessed the safety and effectiveness of vernakalant when used in the emergency department setting (ED group) or in an inpatient hospital setting (non-ED group). Methods: This post hoc analysis of the international, observational, post-authorization SPECTRUM study included 1,289 and 720 recent-onset AF episodes in adults in the ED and non-ED groups, respectively. Safety endpoints included the evaluation of pre-defined health outcomes of interest (HOIs) and other serious adverse events (SAEs) during vernakalant treatment and during the first 24 h after the last infusion. Effectiveness endpoints comprised the rate of successful vernakalant cardioversion, the time from the start of the vernakalant infusion to cardioversion, and the length of hospital stay. Data were analysed using descriptive statistics. Results: The safety profile of vernakalant was similar in the ED and non-ED groups. In the ED group, 12 pre-defined HOIs were reported in 11 patients (0.9%); all but one occurred within 2 h after start of the first infusion. These events comprised nine significant bradycardia cases, of which one was associated with transient hypotension and three with sinus arrest, and 2 cases of atrial flutter with 1:1 conduction. Five other SAEs were reported. All patients with vernakalant-related events recovered without sequelae. No Torsade de Pointes, ventricular fibrillation, or deaths occurred. Successful cardioversion was reported in 67.8% (95% confidence interval: 65.2–70.4) and 66.4% (62.5–70.1) of episodes, with a median time to conversion of 11.0 and 10.0 min in the ED and non-ED groups, respectively. Patients had a median length of hospital stay of 7.4 h and 17.1 h in the ED and non-ED groups, respectively. Conclusion: Intravenous vernakalant was well tolerated with similar cardioversion rates in patients treated in the ED or non-ED setting and does not require admission to a coronary care unit or intensive care unit. First-line treatment with vernakalant could allow an early discharge in patients with recent-onset AF treated in the ED.

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Section: Discussionmentioning

confidence: 99%

Vernakalant for Cardioversion of Recent-Onset Atrial Fibrillation in the Emergency Department: The SPECTRUM Study

Bager¹,

Martı́n²,

Dalmau³

et al. 2022

Cardiology

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“…Of the antiarrhythmic medications used by study participants, three are widely known and popular for use in clinical practice worldwide -amiodarone, propafenone and sotalol (Rajagopalan and Curtis, 2012). Extremely limited data is available regarding ethacizine and its efficacy.…”

Section: Discussionmentioning

confidence: 99%

Sinus Rhythm Maintenance After Electrical Cardioversion for Atrial Fibrillation in High-Risk Patients — Comparative Efficacy of Antiarrhythmic Medications

Kokina

Strēlnieks

Pupkevica

et al. 2021

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Atrial fibrillation (AF) conversion to sinus rhythm by electrical cardioversion (ECV) is followed by the challenge of preventing arrhythmia recurrence, especially in high-risk patients. The properties of class IC, class III and also class II antiarrhythmic medications have been established, but not all effects have been studied. The aim of the study was to compare efficacy of class IC and class III antiarrhythmic medications, and additionally medication with a class II mechanism of action, or taken concomitantly with a beta-blocker, for post-cardioversion sinus rhythm maintenance in patients with high-risk AF. A total of 112 patients who underwent successful ECV in Latvian Centre of Cardiology were included. Data was acquired by a face-to-face interview and 1-, 3-, 6-month follow-up interviews. Comparing class IC (used by 34.8%) and class III (used by 65.2%) drugs, there was no statistically significant difference between six-month sinus rhythm maintenance rates (53.8% vs. 63.0%, p = 0.346) and arrhythmia-free survival (p = 0.313). Comparing amiodarone (used by 57.1%) and ethacizine, concurrently with a beta-blocker (used by 25.9%), no statistically significant difference was found between six-month sinus rhythm maintenance (64.1% vs. 58.6%, p = 0.616) and arrhythmia-free survival (p = 0.706). The results showed that specific antiarrhythmic drug choice was not associated with superior effectiveness, highlighting that, if not contraindicated, ethacizine, concomitantly with a beta-blocker, could be used as a similarly effective alternative for amiodarone, which has adverse health effects.

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“…Electrical cardioversion delivers a direct current synchronization with the R wave. It is usually done using external, transcutaneous electrode patches or internal cardiac electrodes [14]. All these treatment strategies have been shown as valuable options in case of postcardiotomy AF [12-14], however so far there has been no evidence regarding efficacy of stepwise escalating therapy using vernacalant, flecainide and EC after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study

Zeriouh

Sabashnikov

Choi

et al. 2014

J Cardiothorac Surg

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ObjectiveThe aim of this prospective observational study was to evaluate the efficiency of a new escalating treatment strategy with vernakalant, flecainide and electrical cardioversion (EC) in patients with new onset atrial fibrillation (AF) after cardiac surgery.Material and methods24 patients with new onset AF after aortic valve surgery, coronary artery bypass surgery or combined procedures were evaluated in this study. Additional including criteria were age between 18 and 80, duration of AF less than four days, body weight less than 100 kg and no previous treatment with class I or III antiarrhythmic drugs. Exclusion criteria were poor left ventricular ejection fraction (LVEF < 40%) and history of myocardial infarction within 30 days. The patients were divided into converters and non-converters according to their response to combination treatment with vernakalant and flecainide, and the groups were compared.ResultsThe mean age of the population was 69.6 ± 6.3 years and 26.1% of patients were female. There were no statistically significant differences between the two groups in terms of height, weight, gender distribution, comorbidities, preoperative medication, left ventricular function and left atrium diameter. Interventricular septum (IVS) in the non-converted group was significantly thicker compared to the converted group: 14.0 ± 1.00 vs. 10.40 ± 2.59 mm (p = 0.036). While 14 patients (60.9%) were successfully converted into stable sinus rhythm by pharmacological treatment with vernakalant and flecainide, 9 patients (39.1%, non-converted group) remained in AF. However, seven of them could be converted after additional EC.ConclusionThe combination of vernakalant and flecainide improves the conversion rate into a stable sinus rhythm in postcardiotomy patients with new onset AF compared to single drug therapy. Furthermore it might be an excellent precondition for successful EC in patients who are not converted after using both antiarrhtythmic drugs. Furthermore, left ventricular hypertrophy might be a potential negative predictor of successful pharmacological cardioversion.

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Contemporary Approach to Electrical and Pharmacological Cardioversion of Atrial Fibrillation

Cited by 7 publications

References 88 publications

Vernakalant for Cardioversion of Recent-Onset Atrial Fibrillation in the Emergency Department: The SPECTRUM Study

Vernakalant for Cardioversion of Recent-Onset Atrial Fibrillation in the Emergency Department: The SPECTRUM Study

Sinus Rhythm Maintenance After Electrical Cardioversion for Atrial Fibrillation in High-Risk Patients — Comparative Efficacy of Antiarrhythmic Medications

A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study

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