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

Murray, Gary L.

doi:10.1055/s-0036-1584880

Cited by 8 publications

(13 citation statements)

References 23 publications

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“…For instance, instead of beta-blockers, class III anti-arrhythmic drugs may be prescribed when the arrhythmia mechanism is found to be re-entry. Interestingly, ranolazine (originally intended as an anti-anginal drug) has recently been shown to reduce triggered PVCs based on its suppression of early or delayed afterdepolarizations [ 39 , 40 ]. Additional studies are required to clarify whether this drug might be useful for the treatment of VAs for which the underlying mechanism is thought to be triggered activity.…”

Section: Discussionmentioning

confidence: 99%

Coupling interval variability of premature ventricular contractions in patients with different underlying pathology: an insight into the arrhythmia mechanism

Vries

Martirosyan

Domburg

et al. 2018

J Interv Card Electrophysiol

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PurposeCoupling interval (CI) variability of premature ventricular contractions (PVCs) is influenced by the underlying arrhythmia mechanism. The aim of this study was to compare CI variability of PVCs in different myocardial disease entities, in order to gain insight into their arrhythmia mechanism.MethodsSixty-four patients with four underlying pathologies were included: idiopathic (n = 16), non-ischemic dilated cardiomyopathy (NIDCM) (n = 16), familial cardiomyopathy (PLN/LMNA) (n = 16), and post-MI (n = 16)-associated PVCs. The post-MI group was included as a reference, on account of its known re-entry mechanism. On Holter registrations, the first 20 CIs of the dominant PVC morphology were measured manually after which median ΔCI and mean SD of CI/√R-R (= CI of PVC corrected for underlying heart rate) were obtained. Two observers independently measured PVC CIs on pre-selected Holter registrations in order to determine inter- and intra-observer reliability.ResultsThe largest ΔCI was seen in the PLN/LMNA group (220 ms (120–295)), the lowest in the idiopathic group (120 ms (100–190)). The ΔCI in the PLN/LMNA group was significantly larger than the post-MI group (220 ms (120–295) vs 130 ms (105–155), p = 0.023). Mean SD of CI/√R-R in the PLN/LMNA group was also significantly higher than in the post-MI group (p = 0.044). Inter- and intra-observer reliability was good (ICC = 0.91 vs 0.86 and 0.96 vs 0.77, respectively).ConclusionsLow ΔCI and SD of CI/√R-R of idiopathic and NIDCM PVCs suggest that the underlying arrhythmia mechanisms might be re-entry or triggered activity. Abnormal automaticity or modulated parasystole are unlikely mechanisms. High CI variability in PLN/LMNA patients suggests that the re-entry and triggered activity are less likely mechanisms in this group.Electronic supplementary materialThe online version of this article (10.1007/s10840-017-0309-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Coupling interval variability of premature ventricular contractions in patients with different underlying pathology: an insight into the arrhythmia mechanism

Vries

Martirosyan

Domburg

et al. 2018

J Interv Card Electrophysiol

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“…Doses of 500 -1,000 mg RAN b.i.d. were given to 34% and 66% of patients, respectively, and Holters were repeated (mean 3.1 months) [21].…”

Section: Research Methodology (1)chf Studymentioning

confidence: 99%

“…RAN is an effective and safe treatment of adults with symptomatic PVCs [21]. RAN prolongs the QT interval by approximately 6 msec due to IKr inhibition, EADs/DADs are suppressed and there is no transmural dispersion of repolarization, so RAN is protective against torsades.…”

Section: Eventsmentioning

confidence: 99%

Re-Print- COVID-19 Cardiac Complications: Is an Easy, Safe treatment Strategy Right under Our Noses?

Murray¹

2020

JCCI

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Background: Many chronic conditions, as Diabetes Mellitus (DM) and cardiovascular Diseases, suffer Major Adverse Cardiac Events (MACE): congestive heart failure (CHF), Ventricular Tachycardia (VT), Ventricular Fibrillation (VF), Acute Coronary Syndromes [ACSs], and Sudden Cardiac Death (SCD). Acute infections, like COVID-19, also involve oxidative stress, leading to increased Sympathetic tone (S) and decreased Parasympathetic tone (P), increasing Sympathovagal Balance (SB) and MACE. The antioxidant (r) Alpha Lipoic Acid (ALA) improves SB. The antianginal Ranolazine (RAN), also an antioxidant, is an antiarrhythmic. Our studies of their effects on MACE, in DM, and non-DM patients with CHF, ventricular arrhythmias and SCD are reviewed herein, as our findings may apply to acute diseases, such as COVID-19. Methods: (1) In a case-control study, 109 CHF patients, 54 were given adjunctive off-label RAN added to ACC/AHA Guideline therapy (RANCHF). MACE and SB were compared with 55 NORANCHF patients; mean f/u 23.7 mo. (2) 59 adults with triggered premature ventricular contractions (PVCs), bigeminy, and VT were given off-label RAN. Pre- and post-RAN Holters were compared; mean f/u 3.1 mo. (3) 133 DM II with cardiac diabetic autonomic neuropathy were offered (r) ALA; 83 accepted; 50 refused. P&S were followed a mean of 6.31 years, and SCDs recorded. Results: (1) 70% of RANCHF patients increased LVEF 11.3 EFUs (p ≤ 0.003), SCD reduced 56%; VT/VF therapies decreased 53%. (2) 95% of patients responded: VT decreased 91% (p<0.001). (3) SCD was reduced 43% in DM II patients taking (r) ALA (p=0.0076). Conclusion: RAN, (r) ALA treat CHF, VT, and prevent SCD. Trials in COVID-19 are needed.

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“…In the case of re-entry, interrupting re-entry with a class III antiarrhythmic drug would be more appropriate (AlMahameed and Ziv 2019). In the case of triggered activity, early or delayed afterdepolarization can be suppressed with ranolazine (Murray 2016).…”

Section: Introductionmentioning

confidence: 99%

Preliminary Study of Coupling Intervals of Premature Ventricular Complexes in Dogs With Different Cardiac Diseases

Köster¹,

Abbott²

2021

Preprint

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Coupling interval (CI), the time (ms) from the onset of a sinus QRS to the onset of the following premature ventricular complex (PVC), and their variability (CIV) might predict mortality and elucidate mechanisms of arrhythmogenesis. There has been limited investigation of CIV in dogs. Therefore, we determined CIV and prematurity index (PI) in three groups of dogs with ventricular arrhythmias that were subject to 24 hour ambulatory electrocardiographic (Holter) monitoring. Dogs in group 1 had presumptive arrhythmogenic right ventricular cardiomyopathy (ARVC), those in group 2 had structural heart disease in which patients with valvular heart disease predominated, and those in group 3 had a dilated cardiomyopathy (DCM) either phenotype or presumed familial cardiomyopathy. In this preliminary study, we did not find significant differences in indices of CIV between groups. Median PI was lower in dogs treated with antiarrhythmic therapy. Severity of cardiac remodeling, except for left atrial to aortic ratio, were not correlated with CIV. It was not possible to determine the mechanism of arrhythmias in ARVC, DCM phenotype or structural heart disease groups and re-entry, triggered activity, and abnormal automaticity are possible etiologies. The effect of antiarrhythmic therapy demonstrated potential drug effect on CIV. Risk for malignant arrhythmias and sudden cardiac death were not examined. A larger study would be needed to determine if differences exist; if present, this would give insight into possible mechanisms and optimal antiarrhythmic therapy.

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

Cited by 8 publications

References 23 publications

Coupling interval variability of premature ventricular contractions in patients with different underlying pathology: an insight into the arrhythmia mechanism

Coupling interval variability of premature ventricular contractions in patients with different underlying pathology: an insight into the arrhythmia mechanism

Re-Print- COVID-19 Cardiac Complications: Is an Easy, Safe treatment Strategy Right under Our Noses?

Preliminary Study of Coupling Intervals of Premature Ventricular Complexes in Dogs With Different Cardiac Diseases

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