Comparison of effectiveness of ranolazine plus amiodarone versus amiodarone alone for conversion of recent-onset atrial fibrillation
Abstract
Ranolazine, an antianginal agent with antiarrhythmic properties, prevents atrial fibrillation (AF) in patients with acute coronary syndrome. In experimental models, the combination of ranolazine and amiodarone has marked synergistic effects that potently suppress AF. Currently, the clinical effect of the ranolazine-amiodarone combination for the conversion of AF is unknown. This prospective randomized pilot study compared the safety and efficacy of ranolazine plus amiodarone versus amiodarone alone for the conversion of recent-onset AF. We enrolled 51 consecutive patients with AF (<48-hour duration) eligible for pharmacologic cardioversion. Patients (33 men, 63 ± 8 years of age) were randomized to intravenous amiodarone for 24 hours (group A, n = 26) or to intravenous amiodarone plus oral ranolazine 1,500 mg at time of randomization (group A + R, n = 25). The 2 groups were well balanced with respect to clinical characteristics and left atrial diameter. Conversion within 24 hours (primary end point) was achieved in 22 patients (88%) in group A + R versus 17 patients (65%) in group A (p = 0.056). Time to conversion was shorter in group A + R than in group A (9.8 ± 4.1 vs 14.6 ± 5.3 hours, p = 0.002). According to Cox regression analysis, left atrial diameter and A + R treatment were the only independent predictors of time to conversion (hazard ratio 5.35, 95% confidence interval 2.37 to 12.11, p <0.001; hazard ratio 0.81, 95% confidence interval 0.74 to 0.88, p <0.001, respectively). There were no proarrhythmic events in either group. In conclusion, addition of ranolazine to standard amiodarone therapy is equally safe and appears to be more effective compared to amiodarone alone for conversion of recent-onset AF.
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Small, open-label studies suggest that ranolazine might enhance the antiarrhythmic effect of amiodarone for cardioversion.
“Small, open-label studies suggest that ranolazine might enhance the antiarrhythmic effect of amiodarone for cardioversion, 681-683”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [681]
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“Ranolaziodarone”—A Synergism You Should Not Miss
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New antiarrhythmic drugs for atrial fibrillation
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Self-citationRanolazine: An Antiarrhythmic and Cardioprotective Agent
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Antiarrhythmic Drug Management of Atrial Fibrillation
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- Authors
- Fragakis, N., Koskinas, K. C., Katritsis, D. G., Pagourelias, E. D., Zografos, T., & Geleris, P.
- Affiliations
- Aristotle University of Thessaloniki (GR)
- Athens Euroclinic (GR)
- Corresponding author
- Koskinas, Konstantinos C.
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 110
- Issue
- 5
- Pages
- 673-677
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2032383957
- Cited by
- 82
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 7 · 2019: 3 · 2018: 4 · 2017: 6 · 2016: 12 · 2015: 7 · 2014: 13 · 2013: 10 · 2012: 5
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- ranolazine, amiodarone, atrial fibrillation, cardioversion, antiarrhythmic drugs, drug combination therapy, left atrial diameter, recent-onset atrial fibrillation
- MeSH terms
- Ranolazine, Acetanilides, Administration, Oral, Aged, Amiodarone, Anti-Arrhythmia Agents, Atrial Fibrillation, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Electrocardiography, Enzyme Inhibitors, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Male, Middle Aged, Pilot Projects, Piperazines, Prospective Studies, Severity of Illness Index, Confidence Intervals, Proportional Hazards Models, Treatment Outcome, Safety Management
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