Mr Guenter Breithardt,
Vernakalant i.v. is a novel antiarrhythmic drug with almost selective effect on atrial repolarization. Several randomized trials have shown that it rapidly converts recent-onset atrial fibrillation after intravenous administration - but not atrial flutter - to sinus rhythm compared to placebo or amiodarone. From the available data, Prof. Alessandro Cappucci from Bologna, Italy, concluded that it is an effective and safe first-choice therapy and that it is even associated with a higher conversion rate early on than amiodarone. The risk of proarrhythmia has been reported as low and associated only with structural heart disease. He pointed out that the just released focused update of the ESC guidelines for the management of atrial fibrillation has given to vernakalant an equal recommendation of Class I Level A as for flecainide, propafenone, or ibutilide. Professor Christian Torp-Pedersen, Gentofte Hospital, Denmark, was the opponent. Both speakers had co-authored previous publications on vernakalant. He pointed out that the potential of other antiarrhythmic drugs like amiodarone, flecainide, propafenone, and sotalol should not be neglected. These drugs all have shown high conversion rates at least within 8 to 24 hours but act admittedly not as fast as vernakalant. He pointed out that amiodarone has been shown to be (relatively) safe even in patients with ischemic heart disease and heart failure whereas other antiarrhythmic drugs including vernakalant should be used with caution or not at all in patients e.g. with heart failure. At the end, both speakers agreed that vernakalant is an important alternative in the setting of recent onset atrial fibrillation that allows early discharge of the patient from hospital and that can safely be used in patients without structural heart disease. They also agreed that aspects of cost-effectiveness have to be taken into account.
Atrial fibrillation - controversies in medical treatment
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