[calc_vernakalant]
Indications for vernakalant
Vernakalant (Brinavess) is indicated in adults for chemical conversion of recent onset atrial fibrillation to sinus rhythm. Vernakalant is used in the following settings:
Non-surgery patients: atrial fibrillation ≤7 days duration.
Post-cardiac surgery: atrial fibrillation ≤3 days duration.
Vernakalant does not convert atrial flutter to sinus rhythm. Vernakalant is only administered in a monitored clinical setting appropriate for cardioversion.
Administration of vernakalant
Vernakalant (Brinavess) is administered as an infusion.
The infusion is diluted to 4 mg/ml and administered over 10 minutes.
A maximum of two infusions can be given. Each infusion should be completed, even if the patient reverts to sinus rhythm.
The infusion must be aborted if hypotension or bradycardia occurs. A defibrillator should be immediately available as a precaution.
Dosage of vernakalant
Vernakalant is dosed by body weight, with the maximum dose based upon 113 kg.
Normal dilution: 4 mg/ml.
Recommended initial dose: 3 mg/kg, given over 10 minutes. Maximum initial dose of 339 mg, which is 84.7 ml of the 4 mg/ml solution. A second infusion may be started if the initial infusion does not result in conversion to sinus rhythm within 15 minutes after the end of the infusion.
Recommended second dose: 2 mg/kg, given over 10 minutes. Maximum infusion of 226 mg, which is 56,5 ml of the 4 mg/ml solution.
Cumulative doses of more than 5 mg/kg should not be given within 24 hours.
If conversion to sinus rhythm is not successful, blood pressure and ECG should be observed for an additional 15 minutes after the completion of the infusion.
The initiated infusion should always be completed (regardless of whether conversion to sinus rhythm occurs) unless contraindications occur.
If hemodynamically stable atrial flutter occurs after the first dose, the second dose can still be given, as the patient can convert to sinus rhythm.
Dose adjustments
Patients with body weight > 113 kg: The initial dose is 339 mg (84.7 ml of the 4 mg/ml solution). A second 10-minute infusion of 226 mg (56.5 mL of the 4 mg/mL solution) may be administered.
After cardiac surgery: No dose adjustments are necessary.
Impaired renal function: No dose adjustments are necessary.
Impaired liver function: No dose adjustments are necessary.
Elderly (≥ 65 years): No dose adjustments are necessary.
Contraindications to vernakalant
Severe aortic stenosis
Systolic blood pressure < 100 mm Hg.
Heart failure with NYHA class III–IV.
Prolonged QT at baseline (uncorrected > 440 ms), or severe bradycardia, sinus node dysfunction or second degree and third degree heart block in the absence of a pacemaker.
Use of intravenous rhythm control antiarrhythmics (class I and class III) within 4 hours prior to, as well as in the first 4 hours after, vernakalant administration.
Acute coronary syndrome (including myocardial infarction) within the last 30 days.
