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Published on: February 26, 2013
Ranolazine for rhythm control in atrial fibrillation: A systematic review and meta-analysis
Federico Guerra1, Andrea Romandini1, Alessandro Barbarossa1
1Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy.
Background/Objectives:
Available pharmacological options for rhythm control strategy in atrial fibrillation (AF) are limited by sub-optimal efficacy and potentially serious adverse events. The aim of the present meta-analysis is to determine the efficacy and safety of ranolazine for AF management.
Methods:
The present meta-analysis was conducted according to current recommendations (CRD42016039000). Two large medical databases (MEDLINE and Scopus) 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 AF episodes. Secondary efficacy endpoints were: efficacy in converting AF to sinus rhythm, time to conversion, and reduction in AF burden. Safety endpoints included death, serious adverse events, and QTc prolongation.
Results:
Ranolazine was found to be effective in reducing the risk of AF when compared to control (OR 0.47; 95% CI 0.29-0.76; p=0.003). Subgroup analysis showed a larger effect size in post-operative AF (OR 0.29; 95% CI 0.11-0.77; p=0.03) when compared to no post-operative AF (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<0.001). Overall risks of death, adverse events, and QTc prolongation were comparable between ranolazine and control group.
Conclusions:
Ranolazine is an effective option when used for rhythm control strategy in AF. The use of ranolazine seems to be safe and associated with few adverse events.
Insights
Ranolazine effectively manages atrial fibrillation (AF) by reducing AF episodes and improving cardioversion success. This study found ranolazine to be a safe treatment option with minimal adverse events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Pharmacological options for atrial fibrillation (AF) rhythm control have limited efficacy and potential adverse events.
- Existing treatments necessitate a search for safer and more effective alternatives.
Purpose of the Study:
- To evaluate the efficacy and safety of ranolazine for managing atrial fibrillation (AF).
- To assess ranolazine's effectiveness in preventing AF episodes and facilitating rhythm conversion.
Main Methods:
- A meta-analysis of eight randomized clinical trials and two observational studies.
- Systematic literature search across MEDLINE and Scopus databases.
- Primary endpoint: prevention of AF episodes; Secondary endpoints: cardioversion efficacy, time to conversion, AF burden reduction; Safety endpoints: mortality, adverse events, QTc prolongation.
Main Results:
- Ranolazine significantly reduced the risk of AF episodes compared to control (OR 0.47).
- It demonstrated greater efficacy in post-operative AF and enhanced cardioversion success when combined with amiodarone.
- No significant differences in death, adverse events, or QTc prolongation were observed between ranolazine and control groups.
Conclusions:
- Ranolazine is an effective pharmacological option for rhythm control in AF management.
- The drug appears safe, with a low incidence of adverse events, making it a viable therapeutic choice.
