Ranolazine Versus Amiodarone for Prevention of Postoperative Atrial Fibrillation

Abstract

Postoperative atrial fibrillation (AF) is a major complication of cardiothoracic surgery, leading to significant consequences, including a higher rate of stroke, longer hospital stays and increased costs. Amiodarone is among the most widely used agents for prevention of postoperative AF. Ranolazine, a US FDA-approved antianginal agent, has been shown to effectively, safely prevent and terminate nonpostoperative AF in both experimental and clinical studies. In a recent publication, Miles and colleagues directly compared the efficacy and safety of amiodarone and ranolazine for prevention of postoperative AF in 393 patients. The patients were pretreated with amiodarone and ranolaizne for >1 week and 1 day, respectively, and the treatment continued for 10–14 days after surgery. Following coronary artery bypass grafting (CABG), AF occurred in 26.5% of patients taking amiodarone and in 17.5% of patients taking ranolazine (34% reduction; p < 0.035). No differences in adverse events between the two groups of patients were recorded. The results of this retrospective nonrandomized single-center study indicate that ranolazine may be used to effectively and safely prevent postoperative AF. These results need to be confirmed in a larger randomized study. If confirmed, ranolazine may be a good choice for preventing AF in patients undergoing CABG.

Ranolazine: Multifaceted role beyond coronary artery disease, a recent perspective

“…[35] Several small studies have shown that ranolazine in moderate doses significantly shortens the mean time of conversion from AF to sinus rhythm and also reduces the occurrence of AF in coronary artery bypass grafting (CABG). [3637383940]…”

Antiarrhythmic properties of novel antianginal drugs in dog and human cardiac preparations

“…In addition, ranolazine has been proposed to possess antiarrhythmic potential [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] which was principally related to the inhibition of sodium current (I Na ), rapid delayed rectifier potassium current (I Kr ) and calcium current (I Ca ) [27,[46][47][48][49][50]. A suppression of ventricular tachycardias by ranolazine after non-ST-segment elevation myocardial infarction has been proven in the MERLIN-TIMI 36 trial [51].…”