Ranolazine for Atrial Fibrillation: Does Evidence Support Use?

The pharmacological properties of ranolazine, as well as evidence from clinical trials, suggest it may be beneficial in patients with atrial fibrillation. These were the findings from a review published in the Annals of Pharmacotherapy.

Ranolazine (Ranexa; Gilead Sciences) is an antianginal agent FDA-approved for the treatment of chronic angina. Researchers from the University Of Connecticut School Of Pharmacy reviewed several studies which investigated ranolazine in atrial fibrillation patients to see if the available evidence supports its use.

Compared to placebo, ranolazine at higher doses demonstrated a trend toward lower atrial fibrillation recurrence (P=0.053) in the RAFFAELLO trial, however more evidence is needed before ranolazine monotherapy can be supported.

For patients who have had an inadequate response to standard therapy or for whom optimized therapy is hindered by adverse events, adjunctive treatment with ranolazine has provided some benefit in limited studies. Data from the HARMONY trial showed a reduction of 59.1% from baseline in atrial fibrillation burden with ranolazine 750mg plus dronedarone 225mg twice daily (P=0.008 vs. placebo). In another trial, patients who received ranolazine 1500mg once daily in addition to amiodarone IV had a higher conversion rate than patients who received amiodarone monotherapy (P=0.024).

Ongoing studies also suggest the potential of ranolazine therapy in the prevention and treatment of post-cardiothoracic surgery atrial fibrillation but further investigation is needed.

Ranolazine has anti-ischemic and antianginal effects that do not depend upon reductions in heart rate or blood pressure. It does not affect the rate-pressure product, a measure of myocardial work, at maximal exercise. Ranolazine at therapeutic levels can inhibit the cardiac late sodium current.

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