REAL-LIFE EXPERIENCE WITH VERNAKALANT · 2013. 9. 4. · Not for pts with heart disease Propafenone...
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REAL-LIFE EXPERIENCE WITH VERNAKALANT What is the right patient for this drug Juha Hartikainen Heart Center Kuopio University Hospital and University of Eastern Finland Kuopio, Finland
Transcript of REAL-LIFE EXPERIENCE WITH VERNAKALANT · 2013. 9. 4. · Not for pts with heart disease Propafenone...
REAL-LIFE EXPERIENCE WITH VERNAKALANTWhat is the right patient for this drug
Juha Hartikainen
Heart Center
Kuopio University Hospital and University of Eastern Finland
Kuopio, Finland
* Short-duration AF (3 hours to 7 days)
DISCLOSURESJuha Hartikainen
Congress representative of KUH (sponsoser by industry)
Biosense Webster, Medtronic, St Jude Medical, Boehringer Ingelheim, MSD,
Biosense Webster , St. Jude Medical,
Investigator in studies sponsored by industry
Astra Zeneca, Medtronic, St. Jude Medical, Biosense Webster, Boehringer
Ingelheim,
Speaker in symposium sponsored by industry
Cardiome AG, MSD, Astra Zeneca
Advisory board member
Pfizer, Lilly, MSD, Astra Zeneca, Bayer, BMS
* Short-duration AF (3 hours to 7 days)
CARDIOVERSION OF AFDC vs DRUGS
AF - ESC Guidelines Eur Heart J 2012
CARDIOVERSION OF ATRIAL FIBRILLATION
EMERGENCY ROOM
CARDIOVERSION OF ACUTE AFFinFib STUDY*
Ca
rdio
ve
rsio
n (
%)
FinFib Lehto et al. SLL 2011
*40 centers in Finland
FACTS TO CONSIDER
TIME TO CARDIOVERSIONACCESS TO ANESTHESIA / TIME TO GET ANAESHESIA
FACTS TO CONSIDER
TIME TO CARDIOVERSIONMEAL
4-6 hrs
FACTS TO CONSIDER
PATIENT’s WILL
CARDIOVERSION WITH
ANTIARRHYRHMIC DRUGS
ANTIARRHYTHMIC DRUGS IN
AF CARDIOVERSION
Martinez-Marcos et al. Am J Cardiol 2000
* Short-duration AF (3 hours to 7 days)
VERNAKALANT IN
AF* CARDIOVERSION
1. Roy D et al. ACT I Circulation. 2008
Pe
rce
nta
ge
of
Pa
tie
nts
Wit
h
Co
nv
ers
ion
of
AF
Time, minutes
0 1015 20 25 35 50 70 905
0
0.2
0.4
0.6Vernakalant for Infusion (n=145)
Placebo (n=75) 51.7%
4.0%
P<0.001
FACTS TO CONSIDER
VERNAKALANT vs OTHER AAD’sVERNAKALANT (iv) vs FLECAINIDE (po)
Conde et al. Int J Cardiol 2013
FACTS TO CONSIDER
VERNAKALANT vs OTHER AAD’sVERNAKALANT (iv) vs PROPAFENONE (po)
Conde et al. Cardiasc Ther 2013
FACTS TO CONSIDER
VERNAKALANT vs OTHER AAD’sAMIODARONE (iv) vs VERNAKALANT (iv)
Camm et al. JACC 2011
ANTIARRHYTHMIC DRUGS FOR
AF CARDIOVERSION
Amiodarone Slow
Suitable for pts with heart disease
Flecainide Rapid
Not for pts with heart disease
Propafenone Rapid
Not for pts with heart disease
Vernakalant Very rapid
Suitable for pts with mild/moderate
heart disease
VERNAKALANT IN ACUTE AFER, CCU, GENERAL WARD
KUH 2011-2013
KUH data on file 2013
Pa
tie
nts
(n
)
VERNAKALANT IN ACUTE AFER, CCU, GENERAL WARD
KUH 2011-2013
KUH data on file 2013
Succ
ess
ra
te (
%)
Succ
ess
ra
te (
%)
VERNAKALANT IN ACUTE AFER SUCCESS RATE
MALMÖ DATA
Juul-Möller Int J Cardiol in pressn=253 n=352
CARDIOVERSION OF
ATRIAL FIBRILLATION
PACEMAKER PATIENTS
FACTS TO CONSIDER
PACEMAKER PATIENTSPM INTEROGATION AFTER DC
FACTS TO CONSIDER
CARDIOVERSION STRATEGYIMPLANTATION DURING CARDIOVERSION
(%)
VERNAKALANT IN ACUTE AFPACEMAKER PATIENTS
KUH 2011-2013
KUH data on file 2013
Succ
ess
ra
te (
%)
CARDIOVERSION OF
ATRIAL FIBRILLATION
EP LABORATORY
FACTS TO CONSIDER
CARDIOVERSION STRATEGY
CARDIOVERSION WITH AAD DC CARDIOVERSION
FACTS TO CONSIDER
CARDIOVERSION STRATEGYELECTROANATOMIC MAPPING - PATIENT MOVEMENT
FACTS TO CONSIDER
CARDIOVERSION STRATEGYMAPPING AND ABLATION DURING CARDIOVERSION
FACTS TO CONSIDER
CARDIOVERSION STRATEGYEFFECTS ON MAPPING/SUBSTRATE
VERNAKALANT USE IN ACUTE AFEP LABORATORY
KUH 2011-2013P
ati
en
ts (
n)
KUH data on file 2013
VERNAKALANT IN ACUTE AFEP LABORATORY
KUH 2011-2013
KUH data on file 2013
Succ
ess
ra
te (
%)
Hartikainen data on file 2013
SUCCESSFUL
NONSUCCESFUL
p-value
__________________________________________________________
LA SIZE
42.8 + 5.2 mm
45.4 + 3.7 mm
0.034
LA AREA
23.9 + 5.3 cm2
26.2 + 5.1 cm2
NS
LVEF
60.5 + 8.4 %
60.7 + 6.3 %
NS
AGE
58.4 + 7.0 yrs
58.1 + 10.7 yrs
NS
__________________________________________________________
VERNAKALANT IN ACUTE AFEP LABORATORY
SUCCESS RATE vs LA DIAM
VERNAKALANT IN ACUTE AFEP LABORATORY SUCCESS RATE vs LA DIAM
KUH data on file 2013
Succ
ess
ra
te (
%)
VERNAKALANT IN ACUTE AFCONCLUSION
-EMERGENCY ROOM
-CV success RATE c. 65 -70 %
-Can shorten the time to CV and discharge
-PACEMAKER PATIENTS
-CV success rate c. 50 %
-Implantation prodedure can continue during CV (faster procedure)
-No need for PM interrogation after CV (early discharge)
-ELECTROPHYSIOLOGY LABORATORY
-CV success rate c. 50 %
-Allows mapping and ablation during CV (faster procedure)
-Patient movement can be avoided (more precise mapping)
-Does not influence the ”substrate” (PV-line, AVNRT, AVRT, AFL)
jha/18.05.2011
THE END
