Ranolazine in Cardiac Arrhythmia

Saad, Marwan; Mahmoud, Ahmed; Elgendy, Islam Y.; Conti, C. Richard

doi:10.1002/clc.22476

Cited by 21 publications

(18 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, RAN may have a therapeutic role in treating many cardiac conditions, including unstable ischemic patients with PVCs and patients with atrial fibrillation. 23 RAN was very well tolerated, with only 6% of patients experiencing headache, dizziness (not BP-related, but a direct CNS effect), nausea, or constipation, with no known organ toxicity. Patients' symptoms improved proportionally to PVC reduction.…”

Section: Discussionmentioning

confidence: 99%

Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy

Murray¹

2016

Int J Angiol

View full text Add to dashboard Cite

).Ranolazine (RAN) is a novel antianginal agent with antiarrhythmic properties. In the therapeutic concentration range of 2 to 6 μM, RAN inhibits the late sodium current (I Na ), resulting in suppression of early and delayed afterdepolarizations (EAD/DAD), thereby reducing triggered ventricular ectopy. 1 An increase of the late I Na induces EAD/DAD resulting in triggered activity. 2 The diastolic transient inward current in the long QT syndrome 3 is caused by calcium overload and is inhibited by RAN. 3 Because RAN has no known proarrhythmic effects and, to the contrary, protects against torsades de Keywords ► ranolazine ► premature ventricular contractions ► early and delayed afterdepolarizations AbstractEarly and delayed afterdepolarizations (EAD/DAD) cause triggered ventricular ectopy. Because ranolazine (RAN) suppresses EAD/DAD, we postulated that RAN might be effective in reducing premature ventricular contractions (PVCs).To assess the effect of RAN in patients with symptomatic PVCs due to triggered ectopy and its safety and tolerability. A total of 59 patients with symptomatic PVCs were identified from full-disclosure Holters. Doses of 500 and 1,000 mg offlabel RAN, daily, were given to 34 and 66% patients, respectively, and repeat Holters were performed prospectively during mean followup of 3.1 months. The two Holters were retrospectively compared. Congestive heart failure (CHF) was defined as symptoms including dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and fatigue, with a brain natriuretic peptide > 400. Systolic (heart failure with reduced ejection fraction) versus diastolic (heart failure with preserved ejection fraction, HFpEF) CHF depended upon an echocardiographic left ventricular ejection fraction (LVEF) at least 50% by apical two-and four-chamber Simpson's method (HFpEF). The mean age of the patients was 63 years, 60% were males, mean left ventricular ejection fraction was 60%, with 34% having coronary artery disease, 73% were hypertensive, 24% had type 2 diabetic, and 34% were on beta blockers. Upon repeat Holters at a mean of 3.1 months after initiating RAN, 95% (56/59) of the patients had their PVC count reduced as follows: 24% (14/59) had more than 90% decrease, 34% (20/59) had 71 to 90% decrease, and 17% (10/59) had 50 to 70% decrease. In the entire group, RAN reduced PVCs by 71% (mean: 13,329 to 3,837; p < 0.001). Ventricular bigeminy was reduced by 80% (4,168 to 851; p < 0.001), ventricular coupletswere reduced by 78% (374 to 81; p < 0.001), and ventricular tachycardiawas reduced by 91% (56 to 5; p < 0.001). The PVC reduction was dose dependent. Off-label RAN offers an effective and safe pharmacologic treatment for symptomatic triggered PVCs. A large, prospective randomized study is needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy

Murray¹

2016

Int J Angiol

View full text Add to dashboard Cite

show abstract

“…47,48 It is beyond the scope of this review article to go into the details of the possible mechanism of action of ranolazine in arrhythmias; however, several excellent reviews on this topic are available in the literature. 49,50 Table 2 summarises several experimental studies investigating the effects of ranolazine on myocardial electrophysiology. [51][52][53][54] Clinically, the results of ranolazine among patients with AF are limited.…”

Section: Atrial Arrhythmiasmentioning

confidence: 99%

Ranolazine: A true pluripotent cardiovascular drug or jack of all trades, master of none?

Mezincescu

Karthikeyan

Nadar

2018

Sultan Qaboos Univ Med J

View full text Add to dashboard Cite

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Although the majority of patients with CVD are treated with interventional procedures, a substantial number require medical therapy in terms of both prognosis and symptomatic relief. However, commonly used agents such as β-blockers and calcium channel blockers reduce blood pressure in patients whose resting pressures are often already low. Ranolazine is a promising agent that does not have significant effects on blood pressure or heart rate. Use of this drug has been documented in various cardiovascular conditions, including ischaemic heart disease, heart failure and arrhythmias. This review article aimed to examine current evidence on the use of ranolazine in various cardiovascular conditions in order to determine whether it is a true pluripotent cardiovascular agent or, on the other hand, a "jack of all trades, master of none."

show abstract

“…Ranolazine reduces calcium overload in the ischemic cardiomyocyte through inhibition of the late sodium current ( I Na ) [69, 70]. One randomized, controlled trial involving 823 patients with coronary artery disease and taking BBs and CCBs as antianginal therapy demonstrated that the addition of ranolazine 750 mg or 1000 mg two times per day decreased the frequency of anginal attacks, reduced nitroglycerin use, and increased exercise capacity [71].…”

Section: Management Of Anginamentioning

confidence: 99%

Advancements in pharmacotherapy for angina

Jain

Elgendy

Al‐Ani

et al. 2017

Expert Opinion on Pharmacotherapy

View full text Add to dashboard Cite

Introduction Angina pectoris is the most prevalent symptomatic manifestation of ischemic heart disease, frequently leads to a poor quality of life, and is a major cause of medical resource consumption. Since the early descriptions of nitrite and nitrate in the 19th century, there has been considerable advancement in the pharmacologic management of angina. Areas covered Management of chronic angina is often challenging for clinicians. Despite introduction of several pharmacological agents in last few decades, a significant proportion of patients continue to experience symptoms (i.e., refractory angina) with subsequent disability. For the purpose of this review, we searched PubMed and Cochrane databases from inception to August 2016 for the most clinically relevant publications that guide current practice in angina therapy and its development. In this article, we briefly review the pathophysiology of angina and mechanism-based classification of current therapy. This is followed by evidence-based insight into the traditional and novel pharmacotherapeutic agents, highlighting their clinical usefulness. Expert opinion Considering the wide array of available therapies with different mechanism efficacy and limiting factors, a personalized approach is essential, particularly for patients with refractory angina. Ongoing research with novel pharmacologic modalities is likely to provide new options for management of angina.

show abstract

Ranolazine in Cardiac Arrhythmia

Cited by 21 publications

References 38 publications

Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy

Ranolazine is an Effective and Safe Treatment of Adults with Symptomatic Premature Ventricular Contractions due to Triggered Ectopy

Ranolazine: A true pluripotent cardiovascular drug or jack of all trades, master of none?

Advancements in pharmacotherapy for angina

Contact Info

Product

Resources

About