title: Ranolazine for rhythm control in atrial fibrillation: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Available pharmacological options for rhythm control strategy in atrial fibrillation (AF) are limited by sub-optimal efficacy and potentially serious adverse events. The aim of the present meta-analysis is to determine the efficacy and safety of ranolazine for AF management.
  
  
  METHODS
  The present meta-analysis was conducted according to current recommendations (CRD42016039000). Two large medical databases (MEDLINE and Scopus) were systematically searched and from that eight randomized clinical trials and two non-randomized observational studies were identified. The primary endpoint was to determine the efficacy of ranolazine to prevent AF episodes. Secondary efficacy endpoints were: efficacy in converting AF to sinus rhythm, time to conversion, and reduction in AF burden. Safety endpoints included death, serious adverse events, and QTc prolongation.
  
  
  RESULTS
  Ranolazine was found to be effective in reducing the risk of AF when compared to control (OR 0.47; 95% CI 0.29-0.76; p=0.003). Subgroup analysis showed a larger effect size in post-operative AF (OR 0.29; 95% CI 0.11-0.77; p=0.03) when compared to no post-operative AF (OR 0.70; 95% CI 0.54-0.83; p=0.005). Ranolazine increased the chances of successful cardioversion when added to amiodarone over amiodarone alone (OR 3.11; 95% CI 1.42-6.79; p=0.004) while significantly reducing time to conversion (SMD -2.83h; 95% CI -4.69--0.97h; p<0.001). Overall risks of death, adverse events, and QTc prolongation were comparable between ranolazine and control group.
  
  
  CONCLUSIONS
  Ranolazine is an effective option when used for rhythm control strategy in AF. The use of ranolazine seems to be safe and associated with few adverse events.
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy. Electronic address: f.guerra@univpm.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Guerra
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Romandini
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barbarossa
authors.affiliation: InCardaTherapeutics, Inc, Palo Alto, CA, United States.
authors.forename: Luiz
authors.initials: L
authors.lastname: Belardinelli
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D006801:Humans; D000069458:Ranolazine / Q000627:therapeutic use*
chemical_list: D002317:Cardiovascular Agents; D000069458:Ranolazine
keywords: Anti-arrhythmic drug; Atrial fibrillation; Cardioversion; Meta-analysis; Ranolazine; Rhythm control