Background
Indicated for rapid conversion of recent-onset atrial fibrillation (AF) to sinus rhythm in adults who are:
- Non-surgery patients with AF ≤7 days duration
- Post–cardiac surgery patients with AF ≤3 days duration
Contraindications
- Hypersensitivity / allergy to active substance or ingredients of the concentrate.
- Clinical:
- Severe aortic stenosis
- SBP <100 mm Hg
- LVF (NYHA iii or iv)
- Prolonged QT at baseline (uncorrected >440 msec)
- Severe bradycardia
- Sinus node dysfunction
- 2nd or 3rd degree heart block (in absence of a pacemaker)
- Use of iv rhythm-control antiarrhythmics (class I and class III) within 4 hours prior to, and in the first 4 hours after, vernakalant administration
- ACS (including AMI) within last 30 days
- Documented LVEF ≤35%
- Clinically meaningful valvular stenosis
- HOCM or restrictive cardiomyopathy/pericarditis
- Advanced hepatic impairment
Preparation
- Vernakalant (Brinavess) concentrate must be diluted (0.9% NaCl) prior to administration to produce a solution with a vernakalant hydrochloride concentration of 4 mg/ml
- Give via iv infusion (not push) over 10 min in cardiac monitored area
- Stop infusion (and no second dose) if bradycardia or ↓BP
- A pre-infusion checklist should be used (incl. correct hypokalaemia)
Dosage
Body weight: ≥40 kg and <113 kg
- Infusion 3 mg/kg over 10 minutes
- If no cardioversion after 15 min, give a further 2mg/kg infusion over 10 minutes
Body weight ≥113kg
- Infusion : Total dose = 339 mg over 10 minutes
- If no cardioversion after 15 min, give a further 226 mg infusion over 10 minutes
If conversion to sinus rhythm occurs during either the initial or second infusion, that infusion should be continued through completion.
If haemodynamically stable atrial flutter is observed after the initial infusion, the second infusion of vernakalant may be administered, as patients may convert to sinus rhythm.
Other intravenous rhythm-control antiarrhythmics (class I and class III) are contraindicated within 4 hours prior to, as well as in the first 4 hours after, vernakalant.
Resumption or initiation of oral-maintenance antiarrhythmic therapy can be considered 2 hours after administration.