Vernakalant

How it works

It is a relatively atrial-selective agent that blocks early-activating potassium currents and frequency-dependent sodium channels, prolonging atrial refractoriness with limited effect on ventricular repolarisation.

Prescribing in practice

• Contraindicated in significant hypotension, severe aortic stenosis, severe heart failure, recent acute coronary syndrome and marked QT prolongation, with continuous monitoring required during and after infusion.
• Administration should occur in a setting equipped for cardiac monitoring and resuscitation because of the risk of hypotension and serious arrhythmia.
• It is indicated only for short-duration recent-onset atrial fibrillation and not for atrial flutter or long-standing arrhythmia.

Monitoring

Monitor continuous ECG, blood pressure and haemodynamic status throughout the infusion and observation period.

Counselling the patient

• This medicine is given by infusion under close hospital monitoring.
• Report any chest discomfort, palpitations or faintness during treatment immediately.
• You will be observed for a period after the infusion before discharge.

Evidence & guidelines

Randomised trials including the AVRO study demonstrated more rapid conversion of recent-onset atrial fibrillation with vernakalant compared with amiodarone.