Acute Conversion of Atrial Fibrillation in the Emergency Department

Emergency department (ED) visits for acute-onset atrial fibrillation (AF) are common. A drug that acutely converts patients to sinus rhythm safely can decrease ED visit time and lead to early discharge. However, the current U.S. FDA-approved options have low efficacy (procainamide) or risk for torsade (ibutilide), which requires 6 to 8 hours of monitoring after administration.

Intravenous vernakalant is approved in Canada and Europe but not the United States. To test its safety and efficacy for cardioversion, researchers randomly assigned 350 patients with acute AF one-to-one to vernakalant or procainamide.