VERNAKALANT HYDROCHLORIDE FOR THE RAPID CONVERSION OF RECENT-ONSET ATRIAL FIBRILLANTION: PHARMACOLOGY, CLINICAL EFFICACY, AND SAFETY

Background: Atrial fibrillation is a common arrhythmia associated with stroke risk. Vernakalant hydrochloride is an intravenous, atrial-selective antiarrhythmic developed for the rapid conversion of recent-onset AF, offering an alternative to amiodarone, which may cause systemic toxicities. Objective: To review the pharmacological properties, mechanism of action, pharmacokinetics, clinical efficacy, and safety profile of intravenous vernakalant in patients with recent-onset AF. Methods: Pharmacological studies and clinical trials evaluated vernakalant using a 3 mg/kg intravenous infusion over 10 minutes, followed by an optional 2 mg/kg dose after 15 minutes. The maximum doses were 339 mg and 226 mg, respectively. Results: Vernakalant blocks atrial sodium and potassium channels, slowing atrial conduction and prolonging refractoriness. A 3 mg/kg infusion followed by 2 mg/kg, if needed, rapidly converts recent-onset AF to sinus rhythm. Its half-life is approximately 3 hours in extensive CYP2D6 metabolizers and 5.5 hours in poor metabolizers. Common adverse effects include hypotension, nausea, dizziness, dysgeusia, bradycardia, and arrhythmias.