Atrial fibrillation (AF) is a chaotic, irregular atrial rhythm at 300-600 bpm. The AV node conducts the impulse intermittently, causing the irregular ventricular rate. The main risk is of embolism (stroke), which is preventable by anticoagulation. The current estimate of the AF prevalence in the developed world is approxi-mately 1.5-2% in the general population, with the average age of patients with this condition steadily rising to between 75 and 85 years. Hospitalization of patients with AF is also very common. Vernakalant (Brinavess®) is a concentrate that is made up into a solution of infusion (drip into a vein). In recent years, vernakalant has emerged as a novel agent for the termination of recent-onset AF. Forty-seven-year-old man felt chest discomfort and palpitations after a strenuous work (lifting heavy objects). After calling the EMS, the patient was transferred to hospital. When more detailed history was taken, it was established that the patient had the diagnosis of paroxysmal AF for which he was taking Concor 1.25 mg q.d. and Simvastatin 40 mg q.d. BP 160/70 mmHg. ECG was done in the emergency room (ER) which revealed AF with rapid ventricular rate of 135 bpm with no ST–T changes. Laboratory analysis showed: pro BNP 89.1 pg/ml, CK 3.8, venous ABG unremarkable. Cardiac ultrasound was unremarkable and the patient was properly anticoagulated with heparin and enoxaparin in order to receive vernakalant. He was treated with vernakalant 3mg/kg i.v. in the ER. Ten minutes afterwards, a repeated ECG was done showing a normal sinus rhythm at 75 bpm. The patient was discharged from hospital in stable condition. Vernakalant was successful in converting recent-onset AF into the sinus rhythm in the emergency department.
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