IV VERNAKALANT, A REASONABLE SUBSTITUTE FOR ELECTRO CARDIOVERSION FOR A.FIB.

Last night, tired though I was, I attended a close door conference of MSD, as they had invited a German expert, Prof Andreas Goette, to speak to us about the use of IV Vernakalant in the chemo-version of Atrial Fibrillation. Nice dinner first followed by the talk, at KL Hilton.
As we all know, atrial fibrillation is gaining importance as the world's population grow older. It is the most common arrhythmia in the elderly. I use to think that it was part and parcel of old age. Anyway, pharmas have gone on the bandwagon, trying to emphasize that for the elderly to live better, we must treat atrial fibrillation aggressively. So atrial fibrillation, especially recent onset ones, can cause palpitation and be rather uncomfortable. Previous, when there was no bread on the table, these little palpitations were ignored as part of life. Nowadays, that wont do. We must revert all atrial fibrillation. I have one patient whose grandson who is studying medicine in Australia, send an email to me asking me to investigate the episodic palpitation in his grandmother who is 84 years old, and who is now in sinus rhythm. I laughed and explain to the patient and son ( father of medical student ) that I am not keen to chase every rhythm abnormally in a 84 year old. I hope that they can accept that.
Anyway, so now, Prof Andreas taught us that all recent onset atrial fibrillation can be treated with IV Vernakalant, and there is a 45-50% chance of conversion to sinus rhythm. The conversion rate with IV Vernakalant, in the ANVRO study, is certainly better then IV Amiodarone ( the alternative ), but looks like, unless the underlying pproblem is corrected, the atrial fibrillation will recur. It is true that IV Vernakalant is easier to use, the electro-cardioversion, as it does not require long hospital admission and the need for anaesthetic consult.
Vernakalant, like all new anti-arrhythmic agent is a mix class anti-arrhythmic ( is you still follow the Vaughn-Williams classification. It is an atrial slow de-polariser, so it will prolong atrial action potential, with minimal effect on prolonging ventricular depolarisation, thereby avoiding the dreaded torsade de pointe.
Of course MSD ( the maker of IV Vernakalant ), is applying for Malaysian DDA approval ( I gather that that is why it is close door ), so they cannot market it yet.
Well it is good to know that there is another effective atrial anti-arrhythmic around. Lets see what happens in the medium and long term. many anti-arrhythmic have fallen by the way side, after great starts. Only time will tell. We certainly need more data.