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Comparison of Effectiveness of Ranolazine Plus Amiodarone Versus Amiodarone Alone for Conversion of Recent-Onset Atrial Fibrillation
Study Questions:
Does ranolazine augment the therapeutic effect of amiodarone in patients with atrial fibrillation (AF)?
Methods:
Fifty-one patients with AF <48 hours in duration were treated with intravenous amiodarone, 5 mg/kg over 1 hour then 50 mg/h for 24 hours. The patients were randomly assigned to additional treatment with 1500 mg of oral ranolazine (n = 25) or to no additional treatment (n = 26). The primary endpoint was conversion to sinus rhythm within 24 hours.
Results:
There was a trend toward a higher conversion rate in the ranolazine group (88%) than in the control group (65%). The mean time to conversion was significantly shorter in the ranolazine group (9.8 hours) than in the control group (14.6 hours). Concomitant therapy with ranolazine was independently associated with time to conversion (hazard ratio, 0.81). There were no instances of excessive QT prolongation or proarrhythmia in either group.
Conclusions:
The authors concluded that a single oral dose of ranolazine safely accelerates conversion to sinus rhythm in patients with recent-onset AF treated with intravenous amiodarone.
Perspective:
Ranolazine is an antianginal agent and has been found to selectively block sodium channels in the atrium. Whereas amiodarone blocks sodium channels in their inactivated state, ranolazine blocks sodium channels in their activated state. This may explain the potentiation of amiodarone’s effects by ranolazine in patients with AF.
Keywords: Heart Atria, Piperazines
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