Vernakalant Versus Ibutilide In Recent-Onset Atrial Fibrillation - Full Text View

Purpose

Atrial fibrillation is the most common cardiac arrhythmia and is expected to affect about 30 million North Americans and Europeans by 2050. Atrial fibrillation is associated with increased cardiovascular morbidity and mortality, with stroke being an especially important and potentially devastating complication. Many studies have investigated the efficacy of different drugs in converting atrial fibrillation to sinus rhythm. There are numerous randomized controlled trials that have tested the efficacy of agents against placebo and some trials that directly compared the efficacy of two or more different drugs. The class III antiarrhythmic drug Ibutilde is approved for the acute termination of atrial fibrillation and atrial flutter of recent onset and has been shown to be superior to sotalol and equivalent to flecainide in this indication. Recently, the relatively atrial selective antiarrhythmic agent vernakalant has been approved by the European Commission for the rapid conversion of recent onset AF to sinus rhythm in adults. The investigators hypothesize that the period of time needed for cardioversion to sinus rhythm and the efficacy of cardioversion within 90 minutes is different between vernakalant and ibutilide in patients with recent-onset atrial fibrillation.

Condition	Intervention	Phase
Atrial Fibrillation	Drug: Brinavess (Vernakalant) Drug: Corvert (Ibutilide)	Phase 4

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Vernakalant Versus Ibutilide In Recent-Onset Atrial Fibrillation

Resource links provided by NLM:

Genetics Home Reference related topics: familial atrial fibrillation

MedlinePlus related topics: Atrial Fibrillation

Drug Information available for: Ibutilide Ibutilide Fumarate

U.S. FDA Resources

Further study details as provided by Medical University of Vienna:

Primary Outcome Measures:

Time in minutes until conversion to sinus rhythm (measured from the start of the first study drug administration) [ Time Frame: 90 minutes ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Conversion rate to sinus rhythm within 90 minutes (measured from the start of the first study drug administration) [ Time Frame: 90 minutes ] [ Designated as safety issue: No ]

Estimated Enrollment:	100
Study Start Date:	October 2011
Estimated Study Completion Date:	May 2013
Estimated Primary Completion Date:	March 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Vernakalant Initially, patients will be given 3mg/kg Vernakalant in 100ml normal saline over 10min. If atrial fibrillation continues after another 15 minutes of observation, patients will receive a second infusion of Vernakalant (2mg/kg), again over 10 minutes. If the initial rhythm has not converted to sinus rhythm after 2 hours, consented patients will be treated with electrical cardioversion using a standard routine protocol.	Drug: Brinavess (Vernakalant) 3mg/kg Brinavess (Vernakalant) in 100ml normal saline over 10min. If atrial fibrillation continues after another 15 minutes of observation, patients will receive a second infusion of 2mg/kg Brinavess (Vernakalant) over 10 minutes
Active Comparator: Ibutilide Patients will be given 1mg of ibutilide in 100ml normal saline intravenously over 10min. If atrial fibrillation continues after another 10 minutes of observation, patients will receive a second infusion of 1mg ibutilide, again over 10min. If the initial rhythm has not converted to sinus rhythm after 2 hours, consented patients will be treated with electrical cardioversion using a standard routine protocol.	Drug: Corvert (Ibutilide) Patients will be given 1mg of Corvert (Ibutilide) in 100ml normal saline intravenously over 10min. If atrial fibrillation continues after another 10 minutes of observation, patients will receive a second infusion of 1mg ibutilide over 10min.

Arms

Assigned Interventions

Active Comparator: Vernakalant

Initially, patients will be given 3mg/kg Vernakalant in 100ml normal saline over 10min. If atrial fibrillation continues after another 15 minutes of observation, patients will receive a second infusion of Vernakalant (2mg/kg), again over 10 minutes. If the initial rhythm has not converted to sinus rhythm after 2 hours, consented patients will be treated with electrical cardioversion using a standard routine protocol.

Drug: Brinavess (Vernakalant)

3mg/kg Brinavess (Vernakalant) in 100ml normal saline over 10min. If atrial fibrillation continues after another 15 minutes of observation, patients will receive a second infusion of 2mg/kg Brinavess (Vernakalant) over 10 minutes

Active Comparator: Ibutilide

Patients will be given 1mg of ibutilide in 100ml normal saline intravenously over 10min. If atrial fibrillation continues after another 10 minutes of observation, patients will receive a second infusion of 1mg ibutilide, again over 10min. If the initial rhythm has not converted to sinus rhythm after 2 hours, consented patients will be treated with electrical cardioversion using a standard routine protocol.

Drug: Corvert (Ibutilide)

Patients will be given 1mg of Corvert (Ibutilide) in 100ml normal saline intravenously over 10min. If atrial fibrillation continues after another 10 minutes of observation, patients will receive a second infusion of 1mg ibutilide over 10min.

Eligibility

Ages Eligible for Study:	18 Years to 90 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Symptoms of atrial fibrillation since no longer than 48 hours
Age 18 - 90 years

Exclusion Criteria:

Need for immediate electrical cardioversion due to hemodynamic instability (hypotension: systolic blood pressure < 100 mmHg, dyspnea, loss of consciousness, unstable angina)
Moderate to severe heart failure (NYHA III/IV) and patients with previously documented left ventricular ejection fraction (LVEF) ≤ 35%
History or signs of acute coronary syndromes (acute myocardial infarction, unstable angina) within the last 30 days
Resting ventricular rate < 80 beats per minute without pace maker back-up
QT interval of > 440 milliseconds
Wolff-Parkinson-White (WPW) syndrome
History of Torsade de pointes arrhythmias or other polymorphic ventricular tachycardias
Signs of thyreotoxicosis
Sick Sinus Syndrome or atrioventricular block greater than first degree
Severe valvular heart disease, clinically meaningful hypertrophic obstructive cardiomyopathy, restrictive cardiomyopathy, or constrictive pericarditis
Serious disorders of the hepatic, renal (Creatinine > 2.5mg/dl), pulmonary, gastrointestinal, hematologic or central nervous system and serious psychiatric disorders
Abnormal serum electrolytes despite adequate therapy (especially potassium <3.5 mmol/l or > 5.5 mmol/l)
Intravenous use of other Class I or III antiarrythmic drugs within 4 hours of study drug application
Pregnancy (a β-HCG test will be performed in all female subjects apart from women > 50 years and with amenorrhea for at least 12 month (absence of other causes of amenorrhoea)
Known hypersensitivity to study medication

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01447862

Contacts

Contact: Alexander Spiel, MD

+43-1-40400 ext 1964

alexander.spiel@meduniwien.ac.at

Locations

Austria
Medical University of Vienna, Department of Emergency Medicine	Recruiting
Vienna, Austria, A-1090
Contact: Hans Domanovits, MD +43-40400 ext 1964 hans.domanovits@meduniwien.ac.at
Principal Investigator: Hans Domanovits, MD

Sponsors and Collaborators

Medical University of Vienna

More Information

Publications:

Camm AJ, Capucci A, Hohnloser SH, Torp-Pedersen C, Van Gelder IC, Mangal B, Beatch G; AVRO Investigators. A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation. J Am Coll Cardiol. 2011 Jan 18;57(3):313-21.

Domanovits H, Schillinger M, Thoennissen J, Nikfardjam M, Janata K, Brunner M, Laggner AN. Termination of recent-onset atrial fibrillation/flutter in the emergency department: a sequential approach with intravenous ibutilide and external electrical cardioversion. Resuscitation. 2000 Aug 1;45(3):181-7.

Stiell IG, Dickinson G, Butterfield NN, Clement CM, Perry JJ, Vaillancourt C, Calder LA. Vernakalant hydrochloride: A NovelAtrial-selective agent for the cardioversionof recent-onset atrial fibrillation in the emergency department. Acad Emerg Med. 2010 Nov;17(11):1175-82.

Responsible Party:	Hans Domanovits, MD, Medical University of Vienna
ClinicalTrials.gov Identifier:	NCT01447862 History of Changes
Other Study ID Numbers:	Verna-Ibu-AF
Study First Received:	October 5, 2011
Last Updated:	February 21, 2012
Health Authority:	Austria : Federal Ministry for Labour, Health, and Social Affairs

Keywords provided by Medical University of Vienna:

recent-onset

Additional relevant MeSH terms:

Atrial Fibrillation
Arrhythmias, Cardiac
Heart Diseases
Cardiovascular Diseases
Pathologic Processes

Ibutilide
Anti-Arrhythmia Agents
Cardiovascular Agents
Therapeutic Uses
Pharmacologic Actions

ClinicalTrials.gov processed this record on May 19, 2013