{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:04:55Z","timestamp":1790183095875,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Vernakalant is an atrial-selective antiarrhythmic used for rapid pharmacological cardioversion of recent-onset atrial fibrillation. This systematic review and meta-analysis evaluated the efficacy and safety of vernakalant compared with placebo, active antiarrhythmic therapy, and electrical cardioversion. Methods: PubMed, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to August 2026. Randomized clinical trials, clinical trials, and comparative observational studies evaluating vernakalant in adults with atrial fibrillation or atrial flutter were included. Dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals (CIs) using the Mantel\u2013Haenszel random-effects model in RevMan 5.4. Results: Twenty controlled studies involving 4523 patients were included, of whom 2349 received vernakalant and 2174 received control therapy. Vernakalant significantly increased successful conversion to sinus rhythm compared with all controls (1234\/2244 (55%) vs. 991\/2147 (46.2%); RR = 1.63; 95% CI [1.34, 1.99]; p &lt; 0.00001). The effect was strongest versus placebo (RR = 5.33; 95% CI [1.95, 14.60]; p = 0.001) and remained significant versus procainamide (111\/178 (62.3%) vs. 83\/172 (48.2%); RR = 1.29; 95% CI [1.07, 1.57]; p = 0.009) and flecainide (209\/280 vs. 209\/330 (63.3%); RR = 1.18; 95% CI [1.05, 1.33]; p = 0.007), but non-significant against amiodarone, propafenone, ibutilide, or electrical cardioversion. Safety outcomes did not differ significantly between groups, including all-cause mortality (RR = 1.23), drug discontinuation (RR = 0.98), serious adverse events (RR = 0.87), ventricular tachycardia (RR = 0.68), bradycardia (RR = 1.31), and hypotension (RR = 0.80). Conclusions: Vernakalant was associated with higher rates of conversion to sinus rhythm, while no statistically significant differences were observed in major safety outcomes. These findings support its use as a pharmacological option for rapid rhythm restoration in appropriately selected patients.<\/jats:p>","DOI":"10.3390\/jcm15197406","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:10:31Z","timestamp":1790179831000},"page":"7406","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Vernakalant for Cardioversion of Atrial Fibrillation and Flutter: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7668-3920","authenticated-orcid":false,"given":"Abdulrahman A.","family":"Sayed","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5788-0858","authenticated-orcid":false,"given":"Leena","family":"Omair","sequence":"additional","affiliation":[{"name":"College of Medicine, AlMaarefa University, Al Diriyah, Riyadh 13713, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8731-9222","authenticated-orcid":false,"given":"Rawan Saud","family":"Aldreweash","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Majmaah 11952, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9122-1180","authenticated-orcid":false,"given":"Raaina","family":"Mahevish","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1620-2565","authenticated-orcid":false,"given":"Ahmed Turki Badi","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"College of Medicine, Albaha University, Albaha 65799, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9438-1226","authenticated-orcid":false,"given":"Jarah","family":"Almutairy","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0483-807X","authenticated-orcid":false,"given":"Mothana Y.","family":"AlJaber","sequence":"additional","affiliation":[{"name":"College of Medicine, King Faisal University, Al-Ahsa 36362, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7975-4620","authenticated-orcid":false,"given":"Hashim Hussein","family":"Alawami","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahad","family":"Alamoudi","sequence":"additional","affiliation":[{"name":"College of Medicine, AlMaarefa University, Al Diriyah, Riyadh 13713, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara Abdullah","family":"Khamag","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wala Ali Salman","family":"Alhajjaj","sequence":"additional","affiliation":[{"name":"College of Medicine, AlMaarefa University, Al Diriyah, Riyadh 13713, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0098-3542","authenticated-orcid":false,"given":"Kenan Alaa","family":"Badran","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4827-855X","authenticated-orcid":false,"given":"Ayman M. A.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Wybraniec, M., Kampka, Z., and Mizia-Stec, K. (2023). 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