Abstract | AIMS: METHODS AND RESULTS:
MERLIN-TIMI 36 randomized patients with non-ST elevation ACS to ranolazine or placebo. Atrial fibrillation episodes detected on continuous electrocardiogram (cECG) monitoring were reviewed in 6351 patients (97% of trial). Atrial fibrillation burden was categorized according to the time in AF: clinically insignificant AF (<0.01% of time), paroxysmal AF (>0.01-98%), or predominantly persistent AF (>98%). Clinical AF events were identified through adverse event reporting for a median 1-year follow-up. Overall, patients assigned to ranolazine had a trend towards fewer episodes of AF [75 (2.4%) vs. 55 (1.7%) patients, P = 0.08] detected on cECG during the first 7 days after randomization. The pattern of new-onset AF differed between ranolazine vs. placebo: clinically insignificant AF (five patients in ranolazine vs. seven in placebo), paroxysmal AF (18 vs. 48 patients), and predominantly chronic AF (28 vs. 20 patients, three-way P < 0.01). Among patients with a paroxysmal AF pattern, the overall burden was lower with ranolazine than with placebo (median 4.4 vs.16.1%, P = 0.015). Over the median 1-year follow-up, fewer patients treated with ranolazine experienced an AF event compared with placebo (2.9 vs. 4.1%, RR 0.71, P = 0.01). CONCLUSION:
Ranolazine, an anti-anginal agent with electrophysiological effects, may reduce the frequency of paroxysmal AF in patients with non-ST elevation ACS with a pattern of lower overall AF burden in this group. Ranolazine reduced the overall 1-year incidence of clinical AF events. These atrial-specific anti-arrhythmic properties of ranolazine may be of clinical interest and warrant additional investigation. CLINICAL TRIAL REGISTRATION: NCT00099788.
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Authors | Benjamin M Scirica, Luiz Belardinelli, Bernard R Chaitman, Jonathan W Waks, Samuel Volo, Ewa Karwatowska-Prokopczuk, Sabina A Murphy, Mei L Cheng, Eugene Braunwald, David A Morrow |
Journal | Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
(Europace)
Vol. 17
Issue 1
Pg. 32-7
(Jan 2015)
ISSN: 1532-2092 [Electronic] England |
PMID | 25210025
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: [email protected]. |
Chemical References |
- Acetanilides
- Piperazines
- Sodium Channel Blockers
- Ranolazine
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Topics |
- Acetanilides
(administration & dosage)
- Acute Coronary Syndrome
(drug therapy, mortality)
- Age Distribution
- Aged
- Aged, 80 and over
- Atrial Fibrillation
(drug therapy, mortality, prevention & control)
- Comorbidity
- Drug Administration Schedule
- Female
- Humans
- Longitudinal Studies
- Male
- Massachusetts
(epidemiology)
- Piperazines
(administration & dosage)
- Placebo Effect
- Prevalence
- Ranolazine
- Risk Factors
- Sodium Channel Blockers
(administration & dosage)
- Survival Rate
- Treatment Outcome
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