Category: Professional Posters
Purpose: Atrial fibrillation is an increasingly common arrhythmia. It remains one of the strongest cause of stoke and systemic embolism. One of the goals of therapy is to control the symptoms and to improve the quality of life. Patients with recent onset commonly undergo immediate restoration of sinus rhythm by pharmacologic or electrical cardioversion.
Vernakalant hydrochloride is a novel, predominantly atrial selective antiarrhythmic drug that effectively and rapidly converts a new onset of atrial fibrillation. We aimed to retrospectively evaluate the usage of vernakalant at the American University of Beirut Medical Center (AUBMC) since its integration in the formulary.
Methods: This study is a retrospective chart review for all the adult patients who were prescribed vernakalant at the medical center from March 2017 through July 2018. Analysis of the use of this medication included patients demographics (age, gender, weight, height, allergies, admission date, reason for admission, hospital length of stay, past medical and surgical history), indication criteria, presence of any treatment exclusion or a relative exclusion criteria, dose of infusion, monitoring parameters, prescribing physician, place in therapy, adverse drug effects and drug-drug interaction.
Descriptive statistics such as mean values, percentages, and standard deviations, when applicable, were used to summarize to data. Statistical data were generated using SPSS, version 24. Following the AUBMC policy, the MUE did not require approval by any research committee. Informed consent was also waived due to the study design, which aims at quality improvement.
Results: A total of 18 patients were prescribed vernakalant since March 2017 until July 2018. One patient was excluded from the data collection, due to the inability to access the medical record. All patients met the inclusion criteria to prescribe the medication. 82% of the patients required a second dose of 2 mg/kg after a dose of 3 mg/kg. In 29.4% of the cases, a cardiology fellow prescribed the dose and the order set was not used. All monitoring parameters were taken at baseline, but only in 5.8% of the patients they were repeated after 30, 60, 90 and 120 minutes of the start of the infusion. In addition, an electrocardiogram was not done in 100% of the cases. The sodium and potassium levels were monitored for 70.5% of the patients. On the other hand, no adverse effects were observed. A category X interaction was found in 29.4% of the patients, and others of type D was noted in 11.76%.
Conclusion: Despite the low number of patients, this study showed the need to educate the physicians about the necessity to restrict the prescribers to electrocardiologists. Moreover, they should be alerted about the need to monitor blood pressure and heart rate after 30, 60, 90 and 120 minutes after the start of the infusion, to compare potassium and sodium levels before the start of the administration and at the end. Furthermore, they should be educated about the need to do an electrocardiogram after the end of the infusion of vernakalant. Finally, physicians should be informed about the possible interactions with other medications.