open access

Vol 14, No 2 (2019)
Young Cardiology
Published online: 2019-05-22
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Ranolazine — a new drug for patients with recurrent antiarrhythmic therapy-refractory ventricular arrhythmias?

Błażej Kusz, Artur Filipecki, Wojciech Kwaśniewski, Witold Orszulak, Dagmara Urbańczyk-Świć, Artur Chmiel, Andrzej Swinarew, Krzysztof Szydło, Katarzyna Mizia-Stec
DOI: 10.5603/FC.2019.0019
·
Folia Cardiologica 2019;14(2):150-155.

open access

Vol 14, No 2 (2019)
Young Cardiology
Published online: 2019-05-22

Abstract

Introduction. The pharmacological treatment of ventricular arrhythmias (VA) has significant limitations. Ranolazine is a relatively new drug with documented antianginal and anti-ischaemic mechanisms and where preclinical data provides evidence of additional antiarrhythmic properties.  The aim of this article was to evaluate the safety and efficacy of ranolazine in patients with recurrent antiarrhythmic therapy-refractory VA.  Material and methods. This prospective evaluation included 30 patients (pts) (male/female: 26/4; mean age: 65 ± 10 years; coronary artery disease/dilated cardiomyopathy: 20/10; New York Heart Association class I/II/III/IV: 2/14/12/2, left ventricular ejection fraction: 27 ± 10%; implantable cardioverter-defibrillator (ICD): 15 pts, implantable cardioverter- -defibrillator with cardiac resynchronisation therapy (CRT-D): 14 pts with recurrent significant VA [ventricular fibrillation, sustained ventricular tachycardia (VT) and/or non-sustained VT, multiple ventricular premature complexes > 1,000/ /day, biventricular stimulation (BiV) < 95%] and where standard treatment options, i.e. pharmacotherapy, coronary revascularisation, and percutaneous ablation, had proved ineffective. The severity of the arrhythmia was assessed by 24-hour electrocardiographic (ECG) Holter monitoring and in ICD/CRT-D memory recording. The patients received, in addition to the standard pharmacotherapy (amiodarone: 18 pts, beta-blocker: 26 pts) ranolazine 375 mg twice daily for three months. Baseline data was compared to the data obtained after the three months of ranolazine treatment.  Results. We observed a significant reduction of total ventricular extrasystoles determined by ECG Holter monitoring (median: 1,737 vs 1,260, p = 0.04). Similarly, significant VA in ICD/CRT-D memory recording was diminished (67.7 vs 35.5%, p = 0.03). The number of ICD interventions in terms of both antitachycardia pacing (9 pts vs 2 pts, p = 0.01), and shock delivery (8 pts vs 2 pts, p = 0.01), was lower after the three-month observation. The therapy was ineffective for nine (29%) patients — two were hospitalised during the three-month follow-up because of recurrent arrhythmia and in seven pts there was no noticeable reduction in the amount of VA. Adverse effects, in the form of gastrointestinal symptoms (diarrhoea: two, constipation: one), occurred in three (10%) patients.  Conclusions. Authors observed no significant QT prolongation in any patient. There were no differences between the baseline and the post-ranolazine patient clinical characteristics. Ranolazine seems to be a safe and effective second- line therapy in the reduction of VA and ICD interventions in patients with recurrent antiarrhythmic therapy-refractory events.   

Abstract

Introduction. The pharmacological treatment of ventricular arrhythmias (VA) has significant limitations. Ranolazine is a relatively new drug with documented antianginal and anti-ischaemic mechanisms and where preclinical data provides evidence of additional antiarrhythmic properties.  The aim of this article was to evaluate the safety and efficacy of ranolazine in patients with recurrent antiarrhythmic therapy-refractory VA.  Material and methods. This prospective evaluation included 30 patients (pts) (male/female: 26/4; mean age: 65 ± 10 years; coronary artery disease/dilated cardiomyopathy: 20/10; New York Heart Association class I/II/III/IV: 2/14/12/2, left ventricular ejection fraction: 27 ± 10%; implantable cardioverter-defibrillator (ICD): 15 pts, implantable cardioverter- -defibrillator with cardiac resynchronisation therapy (CRT-D): 14 pts with recurrent significant VA [ventricular fibrillation, sustained ventricular tachycardia (VT) and/or non-sustained VT, multiple ventricular premature complexes > 1,000/ /day, biventricular stimulation (BiV) < 95%] and where standard treatment options, i.e. pharmacotherapy, coronary revascularisation, and percutaneous ablation, had proved ineffective. The severity of the arrhythmia was assessed by 24-hour electrocardiographic (ECG) Holter monitoring and in ICD/CRT-D memory recording. The patients received, in addition to the standard pharmacotherapy (amiodarone: 18 pts, beta-blocker: 26 pts) ranolazine 375 mg twice daily for three months. Baseline data was compared to the data obtained after the three months of ranolazine treatment.  Results. We observed a significant reduction of total ventricular extrasystoles determined by ECG Holter monitoring (median: 1,737 vs 1,260, p = 0.04). Similarly, significant VA in ICD/CRT-D memory recording was diminished (67.7 vs 35.5%, p = 0.03). The number of ICD interventions in terms of both antitachycardia pacing (9 pts vs 2 pts, p = 0.01), and shock delivery (8 pts vs 2 pts, p = 0.01), was lower after the three-month observation. The therapy was ineffective for nine (29%) patients — two were hospitalised during the three-month follow-up because of recurrent arrhythmia and in seven pts there was no noticeable reduction in the amount of VA. Adverse effects, in the form of gastrointestinal symptoms (diarrhoea: two, constipation: one), occurred in three (10%) patients.  Conclusions. Authors observed no significant QT prolongation in any patient. There were no differences between the baseline and the post-ranolazine patient clinical characteristics. Ranolazine seems to be a safe and effective second- line therapy in the reduction of VA and ICD interventions in patients with recurrent antiarrhythmic therapy-refractory events.   
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Keywords

ranolazine; ventricular arrhythmias; therapy-refractory arrhythmias

About this article
Title

Ranolazine — a new drug for patients with recurrent antiarrhythmic therapy-refractory ventricular arrhythmias?

Journal

Folia Cardiologica

Issue

Vol 14, No 2 (2019)

Pages

150-155

Published online

2019-05-22

DOI

10.5603/FC.2019.0019

Bibliographic record

Folia Cardiologica 2019;14(2):150-155.

Keywords

ranolazine
ventricular arrhythmias
therapy-refractory arrhythmias

Authors

Błażej Kusz
Artur Filipecki
Wojciech Kwaśniewski
Witold Orszulak
Dagmara Urbańczyk-Świć
Artur Chmiel
Andrzej Swinarew
Krzysztof Szydło
Katarzyna Mizia-Stec

References (11)
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