title: Novel Use of Ranolazine as an Antiarrhythmic Agent in Atrial Fibrillation.
abstract: OBJECTIVE
  To review the limitations of current antiarrhythmic drugs in atrial fibrillation (AF) and discuss the rationale and clinical trials supporting the use of ranolazine in AF.
  
  
  METHODS
  MEDLINE was searched from 1980 to September 2016 using the terms ranolazine, atrial fibrillation, coronary artery bypass grafting, and valve surgery.
  
  
  METHODS
  English-language studies and reviews assessing antiarrhythmic drugs, including ranolazine, were incorporated.
  
  
  RESULTS
  The use of ranolazine monotherapy has been evaluated in 2 clinical trials. In the RAFFAELLO trial, higher doses of ranolazine showed a trend toward lower AF recurrence versus placebo ( P = 0.053), but further evidence is needed to support its use as a sole therapeutic agent. Ranolazine has shown utility in a limited number of studies as an adjunctive agent, which is critical for those in whom standard therapy is inadequate or the adverse event profile precludes optimized standard therapy. In the HARMONY trial, ranolazine 750 mg and dronedarone 225 mg twice daily reduced the AF burden by 59.1% from baseline ( P = 0.008 vs placebo). In a trial by Koskinas and colleagues, patients receiving ranolazine 1500 mg once and intravenous amiodarone had a higher conversion rate than those receiving amiodarone alone ( P = 0.024). There are also promising studies for the prevention and treatment of post-cardiothoracic surgery AF, which require further investigation.
  
  
  CONCLUSIONS
  Ranolazine's pharmacological properties and available evidence suggest potential for its use in AF.
authors.affiliation: 1 University of Connecticut School of Pharmacy, Hartford, CT, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: White
authors.affiliation: 1 University of Connecticut School of Pharmacy, Hartford, CT, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Nguyen
mesh_terms: D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002986:Clinical Trials as Topic; D000077764:Dronedarone; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D000069458:Ranolazine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000069458:Ranolazine; D000077764:Dronedarone; D000638:Amiodarone
keywords: atrial fibrillation; coronary artery bypass; ranolazine; valve surgery