The development of new antiarrhythmic agents for the treatment of atrial fibrillation is advancing simultaneously on several fronts. The molecular structure of existing agents such as amiodarone is being modified in an attempt to improve safety and reduce adverse effects. Similarly, atrial-selective antiarrhythmic drugs are being developed to minimize the occurrence of ventricular proarrhythmia. One of these atrial-selective compounds is vernakalant, which has demonstrated efficacy in terminating atrial fibrillation when given intravenously. In addition, preliminary data suggest that it could also suppress recurrences when used orally. This paper reviews the pharmacology, electrophysiology, efficacy and safety of intravenous and oral vernakalant.
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