Intravenous vernakalant superior to ibutilide in recent on-set AF patients


Researchers in Austria have found shorter time to sinus rhythm in patients with recent-onset atrial fibrillation (AF) treated with intravenous vernakalant (Brinavess, Cardiome Pharma) compared with ibutilide treatment.

Results from the open label, single-centre, randomised controlled study were recently published by Alexander Simon (Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria) and colleagues in Europace.

The study compared the time to conversion to sinus rhythm and conversion rate within 90 minutes in patients with recent-onset AF (<48 hrs duration) treated in the emergency department with intravenous vernakalant (n=49) or ibutilide (n=51).

The study authors concluded that time to conversion of AF to sinus rhythm was significantly shorter in the vernakalant group compared to the ibutilide group (median time: 10 (Interquartile range (IQR) = 6–17) vs. 26 (IQR = 9–55) minutes, p =0.01), and conversion success within 90 minutes was significantly higher in the vernakalant group (69% vs. 43%, log-rank p=0.002). There were no serious adverse events observed in either group.

The authors also found that 59% patients in the vernakalant group compared to 27% patients in the ibutilide group converted to sinus rhythm after the first infusion of study drug (p=0.002). Moreover, the cumulative time to conversion to sinus rhythm (summarising pharmacological and electrical cardioversion), was shorter in the vernakalant group compared to the ibutilide group (median time: 15 (IQR =8–140) vs. 124 (IQR=20–241) minutes).

Additionally, there was no relapse of AF during the six-hour observation period after successful pharmacological cardioversion in either group. Of those who failed to cardiovert with either pharmacologic agent and then underwent electrical cardioversion, 92% in the vernakalant group compared to 65% in the ibutilide group, were successfully cardioverted after one shock.

There were no cases of Torsade de pointes, ventricular fibrillation, polymorphic or sustained ventricular tachycardia, or relevant arterial hypotension in either group.

Kiran Bhirangi, Cardiome’s head of Medical Affairs says,”Ibutilide is a recognised option for the pharmacological cardioversion of AF in treatment guidelines. We are pleased with the degree to which vernakalant appears to have outperformed it in the real-world setting. The investigators from the Medical University of Vienna have added valuable additional insight into the efficacy and safety profile of vernakalant during their pursuit of improving the care of patients who suffer from atrial fibrillation.”

There was no financial or manuscript support from Cardiome Pharma, or any of its subsidiaries, during any stage of this trial.