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DOI: 10.1055/s-0034-1367434
Medical conversion with Vernakalant for postoperative cardio-surgical patients
Objectives: Postoperative atrial fibrillation (AF) is a frequent complication after cardio-surgical operations. Besides electric cardioversion, different medical therapies exist to attenuate atrial fibrillation and normalize heart rhythm. One of these - Amiodaron -suffers from multiple side effects, as it affects non-selectively several atrial and ventricular ion channels. In contrast, the more recent Vernakalant affects selectively the atrium, inhibiting K+ and Na+ channels.
Methods: In a clinical prospective study the conversion rate of Vernakalant in postoperative cardio-surgical patients was assessed. Between 10/2011 and 8/ 2013, 50 (15 females) patients with new AF after surgery, received a first i.v.-administration of Vernakalant (3 mg/kg over 10 min). In case, sinus rhythm (SR) was not achieved within 15 min upon completion of the infusion, a second administration followed (2 mg/kg). The patients (47 to 90 years; mean: 71 years) underwent the following interventions: CABG: 30, MV surgery: 6, AV surgery: 8, CABG + MV: 2, CABG + AV: 3, AV + MV: 1.
Primary outcome was the conversion of AF to SR for at least the following 90 min. Secondary outcome was the proportion of those responders with maintained SR 8 days after surgery.
Results: After the first Vernakalant i.v.-administration, 25 patients (50%) converted to SR, and additional 12 patients (24%) were normalized after the second intake. One patient converted to SR after the first intake, but started fibrillating again after some minutes, so that he received Vernakalant a second time.
Thus, AF was converted in 37 patients (74%) after Vernakalant.
With respect to the non-responders, 6 further patients have developed SR at day 8. This can be well explained by spontaneous conversion (n = 1) or by measures such as Amiodaron (n = 4) or electric cardioversion (n = 1).
Early postoperatively predischarged, 43 patients (86%) of the patients were converted to SR. There were no deaths during the in-hospital stay. Taking strict account on the indication supplied by the manufacturer, there were no side effects within the subject group.
Conclusions: Administration of Vernakalant with a conversion rate of 86% appears a safe, promising option compared to current methods. It permits a medical conversion with a low side-effect profile. Positive effects with regard to the stay on the ICU and the entire in-patient stay can be expected.