Real-world experience with vernakalant in the urgent management of atrial fibrillation: results from the VERITA study

Atrial fibrillation (AF) is the most common arrhythmia encountered in hospital emergency departments (EDs), with pharmacological cardioversion being an effective strategy for restoring sinus rhythm in hemodynamically stable patients. This retrospective observational study aimed to evaluate the effectiveness and safety of vernakalant for the conversion of recent-onset AF under real-world clinical practice conditions, as well as to identify predictors of therapeutic response and adverse events. A total of 263 episodes of AF treated with vernakalant between 2012 and 2022 were analyzed. The overall cardioversion rate was 76.4%, with a median time to conversion of 15 minutes. Administration of the drug more than 12 hours after symptom onset was an independent predictor of therapeutic failure (OR: 4.5; 95% CI: 2.2-9.1; p < 0.001). The incidence of adverse events was 15.2%, occurring more frequently in patients with heart failure or when vernakalant was administered more than 24 hours after symptom onset. No deaths were reported. These findings support the effectiveness and safety profile of vernakalant in the ED setting, highlighting the importance of early administration and underlying cardiovascular comorbidities as key factors influencing therapeutic response and the risk of adverse events.