Palmitoyl-L-carnitine (PC), an ischemic metabolite, causes cellular Na ϩ and Ca 2ϩ overload and cardiac dysfunction. This study determined whether ranolazine [(Ϯ)-1-piperazineacetamide, N-(2,6-dimethylphenyl)-4-[2-hydroxy-3-(2-methoxyphenoxy)propyl]Ϫ] attenuates PC-induced Na ϩ current and ventricular contractile dysfunction of the isolated heart. PC (4 M, 30 min) increased late Na ϩ current by 1034 Ϯ 349% in guinea pig isolated ventricular myocytes; ranolazine (10 M) and tetrodotoxin (TTX, 3 M) significantly attenuated this effect of PC. PC increased left ventricular end-diastolic pressure (LVEDP), coronary perfusion pressure (CPP), wall stiffness, and cardiac lactate and adenosine release from the isolated heart. Ranolazine (10 M) significantly reduced the PC-induced increase in LVEDP by 72 Ϯ 6% (n ϭ 6, p Ͻ 0.001), reduced left ventricular wall stiffness, and attenuated the PC-induced increase of CPP by 53 Ϯ 10% (n ϭ 6 -7, p Ͻ 0.05). Ranolazine (10 M) reduced the PC-induced increases of lactate and adenosine release by 70 Ϯ 8 and 81 Ϯ 5%, respectively (n ϭ 6, p Յ 0.05 for both). TTX (2 M) significantly (p Ͻ 0.05) reduced PC-induced increases of CPP and LVEDP. Pretreatment of isolated myocytes or hearts with the free radical scavenger tiron (4,5-dihydroxy-1,3-benzenedisulfonic acid, disodium salt) (1 mM) significantly reduced the effects of PC to cause increases of late Na ϩ current and LVEDP, respectively, but unlike ranolazine or TTX, tiron did not reverse increases of late Na ϩ current and LVEDP caused by PC. In summary, ranolazine and TTX, inhibitors of the late Na ϩ current, attenuated the PC-induced ventricular contractile dysfunction and increase of coronary resistance in the guinea pig isolated heart. Long-chain acyl carnitines, including palmitoyl-L-carnitine (PC), are intermediates of fatty acid metabolism that accumulate rapidly during brief ischemia (Sobel et al., 1978;DaTorre et al., 1991), secondary to a reduction of tissue oxygenation and mitochondrial lipid oxidation. Hypoxia of 1-h duration was shown to increase the content of long-chain acylcarnitines in sarcolemmal membranes of cultured neonatal rat cardiac myocytes by 70-fold (Knabb et al., 1986). PC has been shown to cause metabolic, electrical, and mechanical cardiac malfunction (Corr et al