Effectiveness and safety of vernakalant vs flecainide for cardioversion of atrial fibrillation in the emergency department: the VERITA study
Dublin Core
Title
Effectiveness and safety of vernakalant vs flecainide for cardioversion of atrial fibrillation in the emergency department: the VERITA study
Subject
Atrial fibrillation, Vernakalant hydrochloride, Flecainide, Arrhythmias, Cardiac, Emergency treatment
Description
Abstract
Background Vernakalant is authorized in several countries, except in the U.S., where the FDA denied its
commercialization due to safety concerns, generating debate about its use.
Objective To compare the effectiveness and safety of intravenous (iv) vernakalant and iv flecainide in the conversion
of atrial fibrillation (AF) to sinus rhythm (SR) in a hospital emergency department (ED).
Design, settings and participants A retrospective observational study was conducted, including all AF episodes
treated with vernakalant or iv flecainide in the ED between January 2012 and December 2022. Clinical characteristics
of each episode were analyzed following routine clinical practice.
Outcomes measure and analysis The primary outcome was the percentage of episodes achieving conversion to
sinus rhythm during the emergency department stay. Secondary outcomes included clinical evolution, emergency
department re-presentations, and outpatient cardiology consultations recorded over a 6-month period. Subgroup
analyses evaluated the effectiveness of vernakalant and flecainide by age, sex, treatment timing, heart failure history,
previous atrial fibrillation episodes, AF type, and CHADS-VAS score.
Main findings A total of 289 patients and 414 AF episodes were included, with 151 treated with flecainide and
263 with vernakalant. The median age was 62 years, and 57.5% were male. Vernakalant converted 76.4% of episodes
to SR during the ED stay, compared to 69.5% with flecainide (p=0.124). AF recurrence at six months was lower
in the vernakalant group (20.1% vs. 29.1%; p=0.043), with fewer ED visits for recurrent AF (0.24 vs. 0.48; p=0.001).
Vernakalant was more effective in early treatment (<12 h after symptom onset) (82.2% vs. 70.7%; p=0.014) and in AF
with rapid ventricular response (78.1% vs. 68.0%; p=0.044). Both drugs were well tolerated, although flecainide was
associated with higher rates of bradycardia, dizziness, and hypotension.
Background Vernakalant is authorized in several countries, except in the U.S., where the FDA denied its
commercialization due to safety concerns, generating debate about its use.
Objective To compare the effectiveness and safety of intravenous (iv) vernakalant and iv flecainide in the conversion
of atrial fibrillation (AF) to sinus rhythm (SR) in a hospital emergency department (ED).
Design, settings and participants A retrospective observational study was conducted, including all AF episodes
treated with vernakalant or iv flecainide in the ED between January 2012 and December 2022. Clinical characteristics
of each episode were analyzed following routine clinical practice.
Outcomes measure and analysis The primary outcome was the percentage of episodes achieving conversion to
sinus rhythm during the emergency department stay. Secondary outcomes included clinical evolution, emergency
department re-presentations, and outpatient cardiology consultations recorded over a 6-month period. Subgroup
analyses evaluated the effectiveness of vernakalant and flecainide by age, sex, treatment timing, heart failure history,
previous atrial fibrillation episodes, AF type, and CHADS-VAS score.
Main findings A total of 289 patients and 414 AF episodes were included, with 151 treated with flecainide and
263 with vernakalant. The median age was 62 years, and 57.5% were male. Vernakalant converted 76.4% of episodes
to SR during the ED stay, compared to 69.5% with flecainide (p=0.124). AF recurrence at six months was lower
in the vernakalant group (20.1% vs. 29.1%; p=0.043), with fewer ED visits for recurrent AF (0.24 vs. 0.48; p=0.001).
Vernakalant was more effective in early treatment (<12 h after symptom onset) (82.2% vs. 70.7%; p=0.014) and in AF
with rapid ventricular response (78.1% vs. 68.0%; p=0.044). Both drugs were well tolerated, although flecainide was
associated with higher rates of bradycardia, dizziness, and hypotension.
Creator
Giuseppe Dominijanni1,4†, Antonio F. Caballero-Bermejo2,5*†, Ana Sainz-Herrero1,4, Álvaro Pineda-Torcuato1,4,
Rosa Capilla-Pueyo1
and Belén Ruiz-Antorán3,5
Rosa Capilla-Pueyo1
and Belén Ruiz-Antorán3,5
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Giuseppe Dominijanni1,4†, Antonio F. Caballero-Bermejo2,5*†, Ana Sainz-Herrero1,4, Álvaro Pineda-Torcuato1,4,
Rosa Capilla-Pueyo1
and Belén Ruiz-Antorán3,5, “Effectiveness and safety of vernakalant vs flecainide for cardioversion of atrial fibrillation in the emergency department: the VERITA study,” Repository Horizon University Indonesia, accessed April 18, 2026, https://repository.horizon.ac.id/items/show/13247.