Reduction in Ventricular Tachyarrhythmia Burden in Patients Enrolled in the RAID Trial
Arwa Younis1, Ilan Goldenberg2, Shamroz Farooq2
1Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA; Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Ranolazine effectively reduces ventricular tachyarrhythmia burden in high-risk patients, particularly those without atrial fibrillation or on other antiarrhythmic drugs. Its efficacy is enhanced in patients with cardiac resynchronization therapy (CRT) ICDs.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- The Ranolazine Implantable Cardioverter-Defibrillator (RAID) trial demonstrated ranolazine's potential to reduce recurrent ventricular tachycardia (VT) requiring implantable cardioverter-defibrillator (ICD) therapy.
- Identifying patient subgroups most likely to benefit from ranolazine is crucial for optimizing treatment strategies.
Purpose of the Study:
- To pinpoint patient populations that experience the greatest reduction in ventricular tachyarrhythmia (VTA) burden with ranolazine treatment.
- To analyze factors influencing VTA burden and the efficacy of ranolazine in diverse patient groups.
Main Methods:
- Utilized Andersen-Gill analyses on data from 1,012 patients in the RAID trial to identify risk factors for VTA burden.
- Defined the primary endpoint as VTA burden, specifically VTA episodes necessitating appropriate treatment.
Main Results:
- Identified seven factors associated with increased VTA burden: prior VT, age ≥65, NYHA class ≥III, QRS duration ≥130 ms, ejection fraction <30%, atrial fibrillation (AF), and concurrent antiarrhythmic drug (AAD) therapy.
- Ranolazine significantly reduced VTA burden in patients not on AADs (HR 0.68) but showed no effect in those on AADs (HR 1.33).
- A significant risk reduction for VTA recurrence was observed in patients with CRT-ICDs (HR 0.64), but not in those with non-CRT ICDs (HR 0.94).
Conclusions:
- Ranolazine is effective in reducing VTA burden among high-risk patients, especially those with CRT-ICDs, without AF, and not on concomitant AADs.
- The addition of ranolazine did not reduce VTA burden in patients already receiving AADs or those with AF.
- The study highlights the importance of patient selection for ranolazine therapy in managing VTA burden.
Background:
The RAID (Ranolazine Implantable Cardioverter-Defibrillator) randomized placebo-controlled trial showed that ranolazine treatment was associated with reduction in recurrent ventricular tachycardia (VT) requiring appropriate implantable cardioverter-defibrillator (ICD) therapy.
Objectives:
This study aimed to identify groups of patients in whom ranolazine treatment would result in the highest reduction of ventricular tachyarrhythmia (VTA) burden.
Methods:
Andersen-Gill analyses were performed to identify variables associated with risk for VTA burden among 1,012 patients enrolled in RAID. The primary endpoint was VTA burden defined as VTA episodes requiring appropriate treatment.
Results:
Multivariate analysis identified 7 factors associated with increased VTA burden: history of VTA, age ≥65 years, New York Heart Association functional class ≥III, QRS complex (≥130 ms), low ejection fraction (<30%), atrial fibrillation (AF), and concomitant antiarrhythmic drug (AAD) therapy. The effect of ranolazine on VTA burden was seen among patients without concomitant AAD therapy (HR [HR]: 0.68; 95% CI: 0.55-0.84; P < 0.001), whereas no effect was seen among those who are concomitantly treated with other AADs (HR: 1.33; 95% CI: 0.90-1.96; P = 0.16); P = 0.003 for interaction. In patients with cardiac resynchronization therapy (CRT) ICDs, ranolazine treatment was associated with a 36% risk reduction for VTA recurrence (HR: 0.64; 95% CI: 0.47-0.86; P < 0.001), whereas among patients with ICDs without CRT no significant effect was noted (HR: 0.94; 95% CI: 0.74-1.18; P = 0.57); P = 0.047 for interaction.
Conclusions:
In patients with high risk for VTA, ranolazine is effective in reducing VTA burden, with significantly greater effect in CRT-treated patients, those without AF, and those not treated with concomitant AADs. In patients already on AADs or those with AF, the addition of ranolazine did not affect VTA burden. (Ranolazine Implantable Cardioverter-Defibrillator Trial [RAID]; NCT01215253).
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