Ranolazine in Persistent Atrial Fibrillation: Evidence From a Case Series of Cardioversions

Direct-current cardioversion (DCCV) is used as a rhythm-control strategy in persistent symptomatic atrial fibrillation (AF) and is often supported by antiarrhythmic drugs (AADs), usually class III AADs, to improve outcomes. Although primarily used as an antianginal agent, ranolazine has also shown evidence of antiarrhythmic properties in AF.

We detail cases where ranolazine was used as an AAD for persistent AF: 6 patients who chemically cardioverted on ranolazine monotherapy and 4 patients on combination therapy with ranolazine and a class III AAD (2 chemical cardioversions and 2 successful DCCVs) who had previously failed DCCV on a class III AAD.

These cases demonstrate ranolazine's beneficial antiarrhythmic effects, both as a single agent and in combination with a class III AAD. This raises the possibility that ranolazine could play a greater role in persistent AF management and merits further investigation in randomized controlled trials.