The rising incidence of
atrial fibrillation (AF) has stimulated researches to identify novel therapeutic options for such most common and refractory
cardiac arrhythmia in clinical practice. Rhythm control strategy is shown to be associated with a lower risk of progression to permanent AF and greater clinical benefit as compared with rate control. Remarkable progress has been witnessed in rhythm control strategy particularly along with the development of mapping and ablation technology, while still should pharmacological
cardioversion serve as an integrated approach for the management of AF especially in the emergency department or centers not equipped with ablation professionals. Concerns regarding the safety and efficacy of existing conventional
antiarrhythmic drugs (AADs) limit their clinical use.
Vernakalant, with its relatively atrial selective antiarrhythmic profile, is developed as a novel AAD for pharmacological
cardioversion of AF. Its mechanisms involve
potassium and
sodium channels blocking effects during atrial action potential. A series of clinical trials have demonstrated the rapid, efficacious and safe effect of
vernakalant over placebo or conventional AADs in terminating recent-onset AF among patients with structurally normal or minimal
heart disease; but current evidence does not show a superior role of
vernakalant in treating long-duration AF or
atrial flutter. More evidence with respect to comparisons of
vernakalant with conventional AADs as well as their synergic effects is needed. Cost-effectiveness analyses of
vernakalant applied in prospective and "real world" practice remain to be assessed.