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.
