Key result
Vernakalant increases successful conversion to sinus rhythm by ~63% versus controls.
Why the study?
The efficacy and safety of vernakalant compared with placebo, active antiarrhythmic therapy, and electrical cardioversion for rapid pharmacological cardioversion of recent-onset atrial fibrillation were evaluated due to limited comprehensive synthesis.
Does vernakalant improve successful conversion to sinus rhythm in adults with atrial fibrillation or atrial flutter?
Meta-Analysis (n=4,523)
Does vernakalant improve successful conversion to sinus rhythm in adults with atrial fibrillation or atrial flutter?
Relative Risk: 1.63 (95% CI 1.34–1.99)
Absolute Event Rate: 55% vs 46.2%
p-value: p=< 0.00001
Vernakalant is associated with higher rates of conversion to sinus rhythm compared to controls, with no significant differences in major safety outcomes, supporting its use for rapid pharmacological cardioversion.
Supports vernakalant for rapid pharmacological cardioversion in recent-onset AF; confirms efficacy and safety across pooled trials.
Background/Objectives: Vernakalant is an atrial-selective antiarrhythmic used for rapid pharmacological cardioversion of recent-onset atrial fibrillation. This systematic review and meta-analysis evaluated the efficacy and safety of vernakalant compared with placebo, active antiarrhythmic therapy, and electrical cardioversion. Methods: PubMed, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to August 2026. Randomized clinical trials, clinical trials, and comparative observational studies evaluating vernakalant in adults with atrial fibrillation or atrial flutter were included. Dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals (CIs) using the Mantel–Haenszel random-effects model in RevMan 5.4. Results: Twenty controlled studies involving 4523 patients were included, of whom 2349 received vernakalant and 2174 received control therapy. Vernakalant significantly increased successful conversion to sinus rhythm compared with all controls (1234/2244 (55%) vs. 991/2147 (46.2%); RR = 1.63; 95% CI [1.34, 1.99]; p < 0.00001). The effect was strongest versus placebo (RR = 5.33; 95% CI [1.95, 14.60]; p = 0.001) and remained significant versus procainamide (111/178 (62.3%) vs. 83/172 (48.2%); RR = 1.29; 95% CI [1.07, 1.57]; p = 0.009) and flecainide (209/280 vs. 209/330 (63.3%); RR = 1.18; 95% CI [1.05, 1.33]; p = 0.007), but non-significant against amiodarone, propafenone, ibutilide, or electrical cardioversion. Safety outcomes did not differ significantly between groups, including all-cause mortality (RR = 1.23), drug discontinuation (RR = 0.98), serious adverse events (RR = 0.87), ventricular tachycardia (RR = 0.68), bradycardia (RR = 1.31), and hypotension (RR = 0.80). Conclusions: Vernakalant was associated with higher rates of conversion to sinus rhythm, while no statistically significant differences were observed in major safety outcomes. These findings support its use as a pharmacological option for rapid rhythm restoration in appropriately selected patients.
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Sayed et al. (2026) conducted a meta-analysis in atrial fibrillation or atrial flutter (n=4,523). Vernakalant vs. placebo, active antiarrhythmic therapy, and electrical cardioversion was evaluated on successful conversion to sinus rhythm (RR 1.63, 95% CI 1.34, 1.99, p=< 0.00001). Vernakalant significantly increased successful conversion to sinus rhythm compared with controls (55.0% vs 46.2%; RR 1.63; 95% CI 1.34-1.99; p<0.00001).
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