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Vernakalant for Pharmacological Cardioversion — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyVernakalant for Pharmacological CardioversionEECC

A 50-year-old man with paroxysmal AF and moderately impaired LVEF (42%) asks about pharmacological cardioversion. Vernakalant is discussed. What is its role?

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Correct answer: C — Use IV vernakalant for selected recent-onset AF

Vernakalant is an atrial-selective antiarrhythmic that blocks atrial potassium and sodium channels with minimal ventricular effect, providing rapid pharmacological cardioversion of recent-onset AF (median time to conversion ~10-12 minutes). The AVRO and ACT trials demonstrated faster cardioversion than IV amiodarone. The 2024 ESC AF Guidelines include vernakalant as an option for pharmacological cardioversion of recent-onset AF (Class IIa), particularly in patients without severe structural heart disease. Contraindications include: SBP <100 mmHg, NYHA III-IV HF, severe AS, recent ACS (<30 days), and QTc >440 ms. Unlike flecainide, vernakalant has been studied in patients with mild-moderate HF (LVEF ≥35%).

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation: https://bnf.nice.org.uk/