Abstract 14059: Ranolazine for Rhythm Control in Atrial Fibrillation: a Systematic Review and Meta-Analysis
Introduction: Current available options for rhythm control strategy in atrial fibrillation (AF) are burdened by sub-optimal efficacy and potentially serious adverse events. For this reason, the development of safer and more effective anti-arrhythmic drugs is still a major medical need. Ranolazine, a drug originally introduced for anti-anginal action, has shown antiarrhythmic mixed properties acting via inhibition of multiple ion currents.
Hypothesis: To test through a meta-analysis the current evidence on efficacy and safety of ranolazine as an anti-arrhythmic option for pharmacological management of AF.
Methods: The present meta-analysis was planned, conducted and reported according to current recommendations (CRD42016039000). Two big medical databases (MEDLINE and Scopus) were systematically searched in order to include all papers up until April 1st, 2016. Eight randomized clinical trials and two non-randomized observational studies were included. The primary endpoint was to test the efficacy of ranolazine in preventing AF episodes. Secondary efficacy endpoints were: a) efficacy in converting atrial fibrillation to sinus rhythm; b) time to conversion to sinus rhythm; c) AF burden reduction. Safety endpoints included death, serious adverse events, and QTc prolongation.
Results: Ranolazine was effective in reducing the risk of AF when compared to control (OR 0.47; 95% CI 0.29-0.76; p=0.003). Subgroup analysis performed confirmed the overall effect size and direction, although a larger effect size was observed for post-operative AF (OR 0.29; 95% CI 0.11-0.77; p=0.03) when compared to non post-operative AF studies (OR 0.70; 95% CI 0.54-0.83; p=0.005). Ranolazine increased the chances of successful cardioversion when added to amiodarone over amiodarone alone (OR 3.11; 95% CI 1.42-6.79; p=0.004) while significantly reducing time to conversion to sinus rhythm (standard mean difference 2.83 hours; 95% CI 4.69-0.97 hours; p<0.001). Overall risks of death, adverse events, and QTc prolongation were comparable between ranolazine and control group (all p=ns).
Conclusions: Ranolazine is an effective option when used for rhythm control strategy in AF. The use of ranolazine seems safe and related to low adverse events and pro-arrhythmic risk.
Author Disclosures: F. Guerra: None. A. Romandini: None. A. Barbarossa: None. A. Capucci: None.
- © 2016 by American Heart Association, Inc.