vernakalant and Stroke

Atrial fibrillation (AF) is associated with increased mortality and morbidity. Although stroke prevention is the only way to improve prognosis, antiarrhythmic drugs (AADs) are of primary importance both in the conversion to sinus rhythm and in the long-term control of rhythm and rate.. We searched the Cochrane Library and Medline Database for articles published in English concerning efficacy and safety of AADs in AF. Particular attention was paid to the recently published European Society of Cardiology guidelines. This review provides an overview of the currently available drugs used in AF, with a particular emphasis on their comparative efficacy and safety in different kind of patients. Recent important findings, and advantages and disadvantages of recently approved drugs such as vernakalant and dronedarone, are also discussed.. AADs remain fundamental in the acute and long-term management of AF, to control symptoms and to reduce the negative impact of the arrhythmia on QoL. The choice of a rate- over rhythm-control strategy should be individualized and based on accurate evaluation of patient medical history and symptoms. New agents will contribute to improve treatment efficacy together with the guarantee of better safety profiles.

Topics: Amiodarone; Anisoles; Anti-Arrhythmia Agents; Atrial Fibrillation; Dronedarone; Heart Rate; Humans; Pyrrolidines; Stroke; Treatment Outcome

Topics: Anisoles; Anti-Arrhythmia Agents; Atrial Fibrillation; Benzimidazoles; beta-Alanine; Catheter Ablation; Dabigatran; Electric Countershock; Humans; Pacemaker, Artificial; Pyrrolidines; Stroke; Thromboembolism

Atrial fibrillation, which is associated with a worsening of congestive heart failure symptoms, an increased rate of stoke, and increased mortality, is still difficult to treat. New therapies must not only increase effectiveness, but also have to have an improved safety profile, in order to avoid sodium channel block in the ventricle of older patients with atrial fibrillation, and also prevent electrical and morphological remodeling. Dronedarone is less effective compared to amiodarone, but has a better side effect profile which leads to fewer discontinuations of treatment. The atrial ion channels are specifically blocked by a number of prospective antiarrhythmic substances. The most advanced is the testing of vernakalant (RSD1235), which primarily suppresses the I(Kur) current. Ranolazine is a new antianginal substance which influences the atrial ion channels and leads to a significant reduction of atrial and more specifically ventricular tachyarrhythmias. A number of other drugs are in development. They will lead to a better understanding of which form of atrial fibrillation can be best treated with which antiarrhythmic agent.

Topics: Acetanilides; Aged; Amiodarone; Animals; Anisoles; Anti-Arrhythmia Agents; Atrial Fibrillation; Dronedarone; Drug-Related Side Effects and Adverse Reactions; Drugs, Investigational; Electrocardiography; Heart Atria; Heart Failure; Heart Ventricles; Humans; Piperazines; Potassium Channels; Pyrrolidines; Ranolazine; Sodium Channels; Stroke

The authors of this Mini-Hot-Topic collection of review manuscripts have provided an outstanding review of the development and current status of several of our most recently developed agents in the fight against atrial fibrillation (AF). They have also given the readers a glimpse into the difficulty of drug development and the contrasts that can exist with the same product in different geographies. For their efforts they have my deepest appreciation. It is my hope that these articles will assist those of you who are clinicians in your care of patients and those of you who are investigators in your appreciation of the drug development process and its hurdles. More specifically, this Mini-Hot-Topic symposium has reviewed for you: (1) the evidence supporting the new novel oral anticoagulants (NOACs) as first-line therapy for prevention of stroke and systemic embolism in patients with "nonvalvular" atrial fibrillation (NVAF); (2) the winding path taken by dronedarone in reaching its current place in our antiarrhythmic armamentarium - in which it still has a role; and (3) the contrasting decisions made with respect to the marketing of vernakalant in Europe versus the United States. Now, in this last manuscript of the collection, I will echo for emphasis some of their highlights and I will also bring you further up to date with respect to a possible future role for dronedarone, as hinted at by the HARMONY trial.

Topics: Amiodarone; Anisoles; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Dronedarone; Embolism; Humans; Pyrrolidines; Stroke