1 Emergency Department, Kuopio University Hospital, Finland.
2 Heart Centre, Kuopio University Hospital, Finland.
Eur Heart J Acute Cardiovasc Care. 2019 Mar;8(2):114-120. doi: 10.1177/2048872617728558. Epub 2017 Aug 29.
: Pharmacological cardioversion of atrial fibrillation is a reasonable alternative for electrical cardioversion in acute atrial fibrillation. We compared the efficacy and safety of intravenous vernakalant and intravenous flecainide in patients with recent-onset (< 48 h) atrial fibrillation.
: A total of 200 consecutive patients, 100 patients undergoing cardioversion with intravenous vernakalant and 100 patients undergoing cardioversion with intravenous flecainide, were included in this single centre non-randomized retrospective study. The primary endpoint was conversion to sinus rhythm within 120 minutes from the drug administration.
: Cardioversion was successful in 67% of patients treated with vernakalant and in 46% of patients treated with flecainide ( p=0.003). Vernakalant (odds ratio 1.99, 95% confidence interval 1.08-3.69, p=0.029) and female gender (odds ratio 2.48, 95% confidence interval 1.22-15.05, p=0.012) were significant predictors of successful cardioversion. The success rate of cardioversion was lowest among men treated with flecainide (36.9%). Patients treated with vernakalant were discharged earlier from the emergency department compared with those treated with flecainide (8.2 ± 4.7 h vs. 12.0 ± 6.0 h, p < 0.001). There was no difference in the complication rate between the groups. Vernakalant treated patients were older (59.3 ± 12.5 vs. 55.4 ± 13.0 years, p=0.03), had higher CHADS-VASc score (1.4 ± 1.3 vs. 0.9 ± 1.2, p = 0.002) and were more often on beta-blocker medication (59% vs. 42%, p= 0.016) than flecainide treated patients.
: Vernakalant was safe, more effective and faster than flecainide in the cardioversion of recent-onset atrial fibrillation. The difference in efficacy was especially apparent among men.
心房颤动的药物复律是急性心房颤动电复律的合理替代方法。我们比较了新近发作（<48 小时）心房颤动患者静脉用 vernakalant 和静脉用 flecainide 的疗效和安全性。
这项单中心非随机回顾性研究共纳入 200 例连续患者，其中 100 例接受 vernakalant 转复，100 例接受 flecainide 转复。主要终点是从给药后 120 分钟内窦性心律的转换率。
vernakalant 治疗组 67%的患者转复成功，flecainide 治疗组 46%的患者转复成功（p=0.003）。vernakalant（优势比 1.99，95%置信区间 1.08-3.69，p=0.029）和女性（优势比 2.48，95%置信区间 1.22-15.05，p=0.012）是转复成功的显著预测因素。flecainide 治疗的男性转复成功率最低（36.9%）。与 flecainide 治疗组相比，vernakalant 治疗组患者更早从急诊室出院（8.2±4.7 小时 vs. 12.0±6.0 小时，p<0.001）。两组并发症发生率无差异。vernakalant 治疗组患者年龄较大（59.3±12.5 岁 vs. 55.4±13.0 岁，p=0.03），CHADS-VASc 评分较高（1.4±1.3 分 vs. 0.9±1.2 分，p=0.002），β受体阻滞剂使用率较高（59% vs. 42%，p=0.016）。
vernakalant 在新近发作的心房颤动转复中比 flecainide 安全、有效且更快。在男性中，疗效差异尤其明显。
