title: Ranolazine for the prevention or treatment of atrial fibrillation: a systematic review.
abstract: The use of currently available antiarrhythmic drugs for atrial fibrillation is limited by their moderate efficacy and the considerable proarrhythmic risk. Ranolazine, an antianginal agent, has been reported to possess antiarrhythmic properties, resulting in a reduction of supraventricular and ventricular arrhythmias. We performed a systematic review of the clinical studies reporting the outcome of patients treated with ranolazine for the prevention or treatment of atrial fibrillation in various clinical settings. We searched PubMed and abstracts of major conferences for clinical studies using ranolazine, either alone or in combination with other antiarrhythmic agents for the prevention or treatment of atrial fibrillation. Ten relevant records were identified. These included both randomized trials and retrospective cohort studies concerning the use of ranolazine in different clinical settings; prevention of atrial fibrillation in patients with acute coronary syndrome, prevention as well as conversion of postoperative atrial fibrillation after coronary artery bypass grafting, conversion of recent-onset atrial fibrillation, sinus rhythm maintenance in drug-resistant recurrent atrial fibrillation and facilitation of electrical cardioversion in cardioversion-resistant patients. A beneficial, mostly modest effect of ranolazine was homogeneously reported in all clinical settings. There were no substantial proarrhythmic effects. No meta-analysis could be performed because for most of the clinical scenarios, there was only one study investigating the effect of ranolazine. Except for one large randomized trial, all the other studies were either relatively small randomized studies or retrospective cohort analyses, which in several cases lacked a control group. This systematic review indicates a modest beneficial effect of ranolazine administered for the prevention or treatment of atrial fibrillation across several clinical settings without substantial proarrhythmic risk.
authors.affiliation: Second Cardiology Department, Attikon University Hospital, University of Athens, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dagres
authors.forename: Efstathios K
authors.initials: EK
authors.lastname: Iliodromitis
authors.forename: John P
authors.initials: JP
authors.lastname: Lekakis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Simitsis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karatzas
authors.forename: Loukianos S
authors.initials: LS
authors.lastname: Rallidis
authors.forename: Eftihia
authors.initials: E
authors.lastname: Simeonidou
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
mesh_terms: D000083:Acetanilides / Q000627:therapeutic use*; D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004554:Electric Countershock; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use*; D000069458:Ranolazine; D012008:Recurrence
chemical_list: D000083:Acetanilides; D000889:Anti-Arrhythmia Agents; D010879:Piperazines; D000069458:Ranolazine