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Ranolazine in Persistent Atrial Fibrillation: Evidence From a Case Series of Cardioversions
Sagarika Raman1, Philip Rutherford1, Calum Presslie1
1Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom.
JACC. Case Reports
|June 20, 2025
Summary
Ranolazine shows promise in treating persistent atrial fibrillation (AF). It effectively achieved chemical cardioversion alone or with other drugs, even in patients who previously failed other treatments.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Persistent symptomatic atrial fibrillation (AF) management often involves direct-current cardioversion (DCCV) supported by antiarrhythmic drugs (AADs), typically class III agents.
- Ranolazine, primarily an antianginal, exhibits antiarrhythmic properties relevant to AF treatment.
Observation:
- Case series detailing ranolazine use in persistent AF patients.
- Six patients achieved chemical cardioversion with ranolazine monotherapy.
- Four patients on combination therapy (ranolazine + class III AAD) experienced successful cardioversion (2 chemical, 2 DCCV) after prior treatment failure.
Findings:
- Ranolazine demonstrated efficacy as both monotherapy and combination therapy for AF cardioversion.
- Successful outcomes were observed even in patients refractory to previous class III AAD therapy.
- Ranolazine facilitated both chemical and electrical cardioversion in persistent AF.
Implications:
- Ranolazine may offer a valuable therapeutic option for persistent AF management.
- The findings suggest ranolazine could play an expanded role in AF rhythm control strategies.
- Further investigation via randomized controlled trials is warranted to confirm these antiarrhythmic effects.
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