RZ shows promise as a safe and convenient agent to facilitate EC in EC-resistant patients. It appears to be most effective in patients whose AF duration is known to be less than 3 months.

Ranolazine is an antianginal agent, which inhibits the abnormal inward Na(+) current and by this inhibition decreases diastolic cardiomyocyte calcium levels and improves electrical stability. Ranolazine has also been shown to be a potent inhibitor of after depolarizations and triggered activity. In this case report, we describe the dramatic antiarrhythmic effects of ranolazine in a patient with nonischemic cardiomyopathy who had malignant ventricular tachycardia. Further research on the antiarrhythmic properties of ranolazine appears warranted.

Background : The "Pill-in-Pocket" (PIP) is an approach to atrial fibrillation (AF) where oral anti-arrhythmics at 75% to 100% of the normal daily dose, given as a single dose, is used to convert recent-onset AF. Pro-arrhythmic risk has limited this approach to patients without structural heart disease (SHD). Ranolazine is an anti-anginal agent, which inhibits the abnormal late Na+ channel current resulting in decreased Na+/Ca++ overload. This inhibits after-depolarizations and reduces pulmonary vein firing, which have been implicated in the initiation and propagation of AF. Ranolazine increases atrial refractoriness and has no known pro-arrhythmic affects. Ranolazine is routinely given to patients with SHD. The ability of Ranolazine to terminate AF in man has not been described but if useful could be a safer PIP agent with application in the presence or absence of SHD. We describe our experience using oral Ranolazine to convert new or recurrent AF.