Effect of ranolazine on atrial fibrillation in patients with non-ST elevation acute coronary syndromes: observations from the MERLIN-TIMI 36 trial
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AIMS: To determine the effect of ranolazine, an anti-ischaemic agent with anti-arrhythmic properties, on the overall burden of atrial fibrillation (AF) in acute coronary syndromes (ACS) and determine whether ranolazine reduces the long-term incidence of clinical AF after ACS. METHODS AND RESULTS: MERLIN-TIMI 36 randomized patients with non-ST elevation ACS to ranolazine or placebo. Atrial fibrillation episodes detected on continuous electrocardiogram (cECG) monitoring were reviewed in 6351 patients (97% of trial). Atrial fibrillation burden was categorized according to the time in AF: clinically insignificant AF (<0.01% of time), paroxysmal AF (>0.01-98%), or predominantly persistent AF (>98%). Clinical AF events were identified through adverse event reporting for a median 1-year follow-up. Overall, patients assigned to ranolazine had a trend towards fewer episodes of AF [75 (2.4%) vs. 55 (1.7%) patients, P = 0.08] detected on cECG during the first 7 days after randomization. The pattern of new-onset AF differed between ranolazine vs. placebo: clinically insignificant AF (five patients in ranolazine vs. seven in placebo), paroxysmal AF (18 vs. 48 patients), and predominantly chronic AF (28 vs. 20 patients, three-way P < 0.01). Among patients with a paroxysmal AF pattern, the overall burden was lower with ranolazine than with placebo (median 4.4 vs.16.1%, P = 0.015). Over the median 1-year follow-up, fewer patients treated with ranolazine experienced an AF event compared with placebo (2.9 vs. 4.1%, RR 0.71, P = 0.01). CONCLUSION: Ranolazine, an anti-anginal agent with electrophysiological effects, may reduce the frequency of paroxysmal AF in patients with non-ST elevation ACS with a pattern of lower overall AF burden in this group. Ranolazine reduced the overall 1-year incidence of clinical AF events. These atrial-specific anti-arrhythmic properties of ranolazine may be of clinical interest and warrant additional investigation. CLINICAL TRIAL REGISTRATION: NCT00099788.
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In a post-hoc analysis of continuous ECG recordings during the first 7 days after randomization, patients assigned to ranolazine had a trend towards fewer episodes of atrial fibrillation than those on placebo (75 [2.4%] vs. 55 [1.7%] patients; P = 0.08).
“In a post-hoc analysis of continuous ECG recordings obtained during the first 7 days after randomization, patients assigned to ranolazine had a trend towards fewer episodes of AF than those on placebo (75 [2.4%] vs. 55 [1.7%] patients; P = 0.08).679”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [679]
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Research works printed but not linked: 1
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Zelniker, T. A., Morrow, D. A., Scirica, B. M., Furtado, J. D., Guo, J., Mozaffarian, D., Sabatine, M. S., & O’Donoghue, M. L. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.017401 · Cited by 26 · see citing works
Self-citation
- Authors
- Scirica, B. M., Belardinelli, L., Chaitman, B. R., Waks, J. W., Volo, S., Karwatowska-Prokopczuk, E., Murphy, S. A., Cheng, M. L., Braunwald, E., & Morrow, D. A.
- Affiliations
- Brigham and Women's Hospital (US)
- Gilead Sciences (United States) (US)
- Saint Louis University (US)
- Corresponding author
- Scirica, B. M.
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-09-10
- Volume
- 17
- Issue
- 1
- Pages
- 32-37
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2147216976
- Cited by
- 58
- References
- 22
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 1 · 2019: 4 · 2018: 4 · 2017: 5 · 2016: 18 · 2015: 6 · 2014: 2 · 2012: 1
- FWCI
- 7.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Gilead Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- ranolazine, atrial fibrillation, non-ST-elevation acute coronary syndrome, antiarrhythmic effect, paroxysmal atrial fibrillation, atrial fibrillation burden, persistent atrial fibrillation, antianginal drugs
- MeSH terms
- Ranolazine, Acetanilides, Aged, Aged, 80 and over, Atrial Fibrillation, Drug Administration Schedule, Female, Humans, Longitudinal Studies, Male, Massachusetts, Piperazines, Risk Factors, Comorbidity, Placebo Effect, Prevalence, Survival Rate, Treatment Outcome, Age Distribution, Sodium Channel Blockers, Acute Coronary Syndrome
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