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Arrhythmias & electrophysiologyRandomised controlled trial

Vernakalant versus procainamide for rapid cardioversion of patients with acute atrial fibrillation (RAFF4): randomised clinical trial

BMJPublished

  • Randomised controlled trial
  • open label
  • multicentre
Read the original article ↗

Authors' conclusion

In this head-to-head comparison, vernakalant was superior to procainamide for patients with higher conversion rates and faster times to conversion.

Study context

Population
ED patients with acute AF for whom acute rhythm control was a safe option, 12 tertiary care EDs in Canada
Participants
350 patients
Comparison
IV vernakalant vs IV procainamide
  • Vernakalantn = 178
  • Procainamiden = 172reference
Primary endpoint
Conversion to sinus rhythm
Follow-up
Within 30 minutes of drug infusion completion

Primary result

As reported in the abstract

within 30 minutes
Each group vs procainamideAdjusted absolute difference (95% CI)P value
Vernakalant
15.0%(4.6%–25.0%)
P = 0.005
Each group vs procainamideAdjusted odds ratio (95% CI)P value
Vernakalant
1.87(1.2–2.9)
P = 0.006

Secondary outcomes

minutes

OutcomeVernakalantProcainamidemean difference (95% CI)P value
Time to conversion21.844.7−22.9 (−29.9 to −16.0)P < 0.001
OutcomeVernakalantProcainamideEstimateP value
Attempted electrical cardioversion33.7%44.2%OR 0.62 (95% CI 0.39–0.96)P = 0.033
Conversion, age <70 years (subgroup)73.3%47.2%adjusted OR 3.1 (95% CI 1.7–5.5)P = 0.001
  • Conversion, age <70 years (subgroup): interaction P=0.005

Safety

Adverse events

Similar in both groups, generally mild and brief

Original publication

Vernakalant versus procainamide for rapid cardioversion of patients with acute atrial fibrillation (RAFF4): randomised clinical trial. BMJ. Published 11 November 2025. doi:10.1136/bmj-2025-085632
Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it