title: The effect of ranolazine on maintaining sinus rhythm in patients with resistant atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) may arise out of anomalous impulse activity at atrial venous junctions. Triggered activity may be a source of abnormal impulse activity. Ranolazine is an anti-anginal agent, which inhibits normal and abnormal late Na+ channel current in the ventricle and peak Na+ channel current in the atrium. This produces an energy sparing effect and stabilizes cardiac membranes. Ranolazine is a potent inhibitor of triggered activity. The purpose of this report is to describe our initial experience with ranolazine used in patients with resistant AF.
  
  
  METHODS
  Seven patients (4 males, 3 females, 67 +/- 9 years) who developed recurrent AF within hours to a few days of restoring sinus rhythm despite AF ablation and /or failing one or more anti-arrhythmic agents were started on ranolazine (500-1000 mg/twice/day) after stopping all other anti-arrhythmic therapy. All but one patient had some form of associated structural heart disease.
  
  
  RESULTS
  Two patients received no apparent benefit from ranolazine developing recurrent AF within 2 days. All other patients derived significant benefit. Four patients have experienced no recurrent AF. The other patient relapsed at 3 months and again at 6 months. The mean time in sinus rhythm to date, or to the first relapse, for the five responders was 27 +/- 11 weeks. No clinically evident pro-arrhythmic episodes occurred.
  
  
  CONCLUSIONS
  Ranolazine was helpful in maintaining sinus rhythm in the majority of patients in which more established measures had failed. A controlled prospective trial is warranted to further investigate the efficacy of ranolazine in AF.
authors.affiliation: Cardiovascular Associates of Northern Wisconsin, S.C., CaRE Foundation, Inc., USA. dkmurdock@charter.net
authors.forename: David K
authors.initials: DK
authors.lastname: Murdock
authors.forename: Naomi
authors.initials: N
authors.lastname: Overton
authors.forename: Mary
authors.initials: M
authors.lastname: Kersten
authors.forename: Jeff
authors.initials: J
authors.lastname: Kaliebe
authors.forename: Fausto
authors.initials: F
authors.lastname: Devecchi