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Ranolazine is an effective for rhythm control in atrial fibrillation

Available pharmacological options for rhythm control strategy in atrial fibrillation are limited by sub-optimal efficacy and potentially serious adverse events.

The aim of meta-analysis was to determine the efficacy and safety of Ranolazine for management of atrial fibrillation.

Two large medical databases were systematically searched and from that eight randomized clinical trials and two non-randomized observational studies were identified.

The primary endpoint was to determine the efficacy of Ranolazine to prevent episodes of atrial fibrillation. Secondary efficacy endpoints were: efficacy in converting atrial fibrillation to sinus rhythm, time to conversion, and reduction in burden of atrial fibrillation.
Safety endpoints included death, serious adverse events, and QTc prolongation.

Ranolazine was found to be effective in reducing the risk of atrial fibrillation when compared to control ( odds ratio, OR 0.47; 95% CI 0.29-0.76; p=0.003 ).

Subgroup analysis showed a larger effect size in post-operative atrial fibrillation ( OR 0.29; 95% CI 0.11-0.77; p=0.03 ) when compared to no post-operative atrial fibrillation ( OR 0.70; 95% CI 0.54-0.83; p=0.005 ).

Ranolazine increased the chances of successful cardioversion when added to Amiodarone over Amiodarone alone ( OR 3.11; 95% CI 1.42-6.79; p=0.004 ) while significantly reducing time to conversion ( SMD -2.83h; 95% CI -4.69 - -0.97h; p less than 0.001 ).

Overall risks of death, adverse events, and QTc prolongation were comparable between Ranolazine and control group.

In conclusion, Ranolazine is an effective option when used for rhythm control strategy in atrial fibrillation. The use of Ranolazine seems to be safe and associated with few adverse events. ( Xagena )

Guerra F et al, Int J Cardiol 2016; Epub ahead of print