Abstract 13798: Effect of Ranolazine on Atrial Fibrillation Among Patients with Non-ST Elevation Acute Coronary Syndromes (NSTEACS) - Observations from the MERLIN-TIMI 36 Trial
Background: Ranolazine was shown to reduce SVT and VT in MERLIN-TIMI 36, with a trend towards a lower incidence of new-onset AF detected continuous ECG (cECG) monitoring for the first 7 days post randomization. The effect of ranolazine on the overall burden of AF on cECG monitoring or effect on the incidence of clinical events related to AF during the one year after randomization is unknown.
Methods: MERLIN-TIMI 36 was a randomized, placebo-controlled trial of ranolazine in 6,560 pts with NSTEACS. All cases of AF detected on cECG monitoring were reviewed and AF burden was calculated as the proportion of recording time (%) in AF. Clinical events due to AF were collected through the adverse event (AE) reporting (serious and non-serious). Serious AEs where further adjudicated by a blinded CEC to determine if the event was symptomatic and related to AF.
Results: AF burden on cECG was categorized into 3 patterns: paroxysmal AF (>0.01-98%, 19 pts in ranolazine v. 46 pts in placebo); predominately chronic AF (>98% of recording time, 28 pts v 20 pts); and clinically insignificant AF (<0.01%, 5 pts v. 7 pts; 3-way p <0.01). Among pts with a paroxysmal AF pattern, the overall burden tended to be lower with ranolazine than placebo (median 5.1% vs.14.1%, p=0.056, Figure-left). Over the median 1 yr f/u, fewer patients given ranolazine reported AE related to AF compared to placebo (2.9% v. 4.1%, RR 0.71, p=0.01, Figure-right), though there was no difference in events adjudicated to be both symptomatic and related to AF (0.1% v. 0.12%, HR 0.81, p=0.41).
Conclusion: Ranolazine, an antianginal agent with electrophysiological effects, reduced the frequency of PAF in pts with NSTEACS with a pattern of lower overall AF burden in this group. Ranolazine reduced the overall incidence of AEs related to AF but did not significantly modify more serious or symptomatic cases. These atrial-specific antiarrhythmic properties of ranolazine may be of clinical interest and warrant additional investigation.
- © 2011 by American Heart Association, Inc.