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Memantine for Premature Atrial Contractions: A Phase 2 Randomized Clinical Trial.

Yunli Shen1, Chunyu Zeng2, Yingxian Sun3

  • 1State Key Laboratory of Cardiovascular Diseases, Shanghai Arrhythmia Research Center, and Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, China (Y.S., W.H., D.X., D.L., Y. Liu, B. Yang, Q.Z., R.D., H.L., B. Zhang, Yizhang Wu, L.Z., S.L., K.X., G.W., Q.Z., B.S., Z.C., Yahan Wu, J. Leng, Y.-H.C.).

Circulation
|March 19, 2026
PubMed
Summary

Memantine significantly reduced premature atrial contractions (PACs) and atrial tachyarrhythmias in a phase 2 trial. This novel approach targeting the cardiac glutamatergic system shows promise for managing symptomatic PACs.

Keywords:
atrial fibrillationatrial premature complexesclinical trialmemantinereceptors, N-methyl-D-aspartate

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Area of Science:

  • Cardiology
  • Pharmacology
  • Electrophysiology

Background:

  • Premature atrial contractions (PACs) are linked to serious cardiovascular conditions like atrial fibrillation and stroke.
  • Currently, no approved pharmacological treatments exist specifically for suppressing PACs.
  • Emerging research highlights a cardiac glutamatergic system, involving N-methyl-D-aspartate (NMDA) receptors, that influences atrial electrical activity.

Purpose of the Study:

  • To evaluate the efficacy and safety of memantine, an NMDA receptor antagonist, in reducing PACs.
  • To investigate memantine's effect on atrial tachyarrhythmia burden and new-onset atrial fibrillation in patients with frequent PACs.

Main Methods:

  • A phase 2, multicenter, randomized, double-blind, placebo-controlled trial was conducted.
  • Symptomatic adults with frequent PACs (≥1000/24 h) received either memantine or placebo for 6 weeks.
  • Primary endpoint: percentage change in 24-hour PAC count; secondary endpoints: responder rate, atrial tachycardia burden, and new-onset atrial fibrillation incidence.

Main Results:

  • Memantine significantly reduced PAC counts compared to placebo (47.1 percentage points difference, P=0.0045).
  • A higher responder rate (≥50% PAC reduction) was observed with memantine (52.4% vs. 23.1%, P<0.0001).
  • Memantine decreased nonsustained atrial tachycardia burden and lowered the incidence of new-onset atrial fibrillation (4.8% vs. 23.9%, P<0.0001) without adverse effects on cardiac function.

Conclusions:

  • Memantine effectively reduced atrial ectopy and tachyarrhythmia burden in patients with frequent symptomatic PACs.
  • The drug demonstrated a favorable safety profile, with no drug-related serious adverse events.
  • These findings support a novel therapeutic strategy targeting the cardiac glutamatergic system for PAC management.