vernakalant and Acute-Disease

This randomized double-blind study compared the efficacy and safety of intravenous vernakalant and amiodarone for the acute conversion of recent-onset atrial fibrillation (AF).. Intravenous vernakalant has effectively converted recent-onset AF and was well tolerated in placebo-controlled studies.. A total of 254 adult patients with AF (3 to 48 h duration) eligible for cardioversion were enrolled in the study. Patients received either a 10-min infusion of vernakalant (3 mg/kg) followed by a 15-min observation period and a second 10-min infusion (2 mg/kg) if still in AF, plus a sham amiodarone infusion, or a 60-min infusion of amiodarone (5 mg/kg) followed by a maintenance infusion (50 mg) over an additional 60 min, plus a sham vernakalant infusion.. Conversion from AF to sinus rhythm within the first 90 min (primary end point) was achieved in 60 of 116 (51.7%) vernakalant patients compared with 6 of 116 (5.2%) amiodarone patients (p < 0.0001). Vernakalant resulted in rapid conversion (median time of 11 min in responders) and was associated with a higher rate of symptom relief compared with amiodarone (53.4% of vernakalant patients reported no AF symptoms at 90 min compared with 32.8% of amiodarone patients; p = 0.0012). Serious adverse events or events leading to discontinuation of study drug were uncommon. There were no cases of torsades de pointes, ventricular fibrillation, or polymorphic or sustained ventricular tachycardia.. Vernakalant demonstrated efficacy superior to amiodarone for acute conversion of recent-onset AF. Both vernakalant and amiodarone were safe and well tolerated in this study. (A Phase III Superiority Study of Vernakalant vs Amiodarone in Subjects With Recent Onset Atrial Fibrillation [AVRO]; NCT00668759).

Topics: Acute Disease; Aged; Amiodarone; Anisoles; Atrial Fibrillation; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pyrrolidines; Treatment Outcome

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anisoles; Anti-Arrhythmia Agents; Atrial Fibrillation; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Pyrrolidines; Treatment Outcome; Young Adult

Emergency medicine physicians aim to stabilize or restore vital functions, establish diagnosis, initiate specific treatments and adequately orientate patients. This year, new evidences have improved our knowledge about diagnostic strategy for patients with acute non traumatic headache, treatment of acute atrial fibrillation and outpatient management of acute pulmonary embolism. Reducing injection pain of local anesthetics, reducing irradiation by using alternative diagnostic tools in appendicitis suspicion, and identification of trauma patients who benefit from tranexamic acid administration are other illustrations of the efforts to improve efficacy, safety and comfort in the management of emergency patients.

Topics: Acute Disease; Ambulatory Care; Anisoles; Antifibrinolytic Agents; Appendicitis; Atrial Fibrillation; Craniocerebral Trauma; Electrocardiography, Ambulatory; Emergencies; Emergency Medicine; Emergency Service, Hospital; Evidence-Based Medicine; Headache; Humans; Practice Guidelines as Topic; Pulmonary Embolism; Pyrrolidines; Randomized Controlled Trials as Topic; Subarachnoid Hemorrhage; Syncope; Tomography, X-Ray Computed; Tranexamic Acid; Ultrasonography; Wounds and Injuries

Topics: Acute Disease; Anisoles; Atrial Fibrillation; Electric Countershock; Evidence-Based Medicine; Humans; Pyrrolidines; Treatment Outcome