Effect of Ranolazine, an Antianginal Agent With Novel Electrophysiological Properties, on the Incidence of Arrhythmias in Patients With Non–ST-Segment–Elevation Acute Coronary Syndrome

Abstract

Background-Ranolazine, a piperazine derivative, reduces ischemia via inhibition of the late phase of the inward sodium current (late I Na ) during cardiac repolarization, with a consequent reduction in intracellular sodium and calcium overload. Increased intracellular calcium leads to both mechanical dysfunction and electric instability. Ranolazine reduces proarrhythmic substrate and triggers such as early afterdepolarization in experimental models. However, the potential antiarrhythmic actions of ranolazine have yet to be demonstrated in humans. Methods and Results-The Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute CoronarySyndrome (

Impact of ranolazine on ventricular arrhythmias – A systematic review

“…A total of 14 studies,8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 which reported data about the impact of ranolazine in ventricular arrhythmias, included in our systematic review (Figure 1). Of these, 2 were randomized controlled trials (MERLIN‐TIMI 36 and RAID), 1 was a randomized crossover trial (RYPPLE), 2 were observational studies, 1 was a case series, and 8 were case reports (Table 1).…”

“…According to MERLIN‐TIMI 36 trial,10 ranolazine suppresses ventricular arrhythmias during the first week after admission for non‐ST elevation acute coronary syndrome, which can decrease the incidence of sudden cardiac death 22. Additionally, the RAID trial showed that ranolazine can significantly decrease VT episodes requiring antitachycardia pacing (ATP) compared to placebo patients while did not show a significant difference in the combined endpoint VT/VF or death.…”

“…Additionally, ranolazine can be used on top of class III drugs as it has been shown that it does not cause pro‐arrhythmia despite a marked effect on ventricular repolarization 48, 49, 50. The beneficial role of ranolazine has also been demonstrated by experimental and human studies in atrial arrhythmias 10, 44, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61…”

Ranolazine: safe and effective in a patient with hypertensive cardiomyopathy and multiple episodes of electrical storm

“…This indirect decrease in intracellular Ca ++  concentration is responsible for the well‐documented antianginal effect of ranolazine 11, 12. In the field of clinical studies, ranolazine is presented as an effective, well‐tolerated, and safe drug, in patients with coronary artery disease and residual reversible ischemia 13, 14.…”

“…Experimental evidence emphasizes the increase in VF threshold and the suppression of ischemia‐induced arrhythmias by ranolazine 17, 18. According to MERLIN‐TIMI 36 trial, ranolazine suppresses VA during the first week after admission for non‐ST elevation acute coronary syndrome 14. In such patients, even short VT episodes of only few beats are associated with the risk of sudden cardiac death 19.…”