Ranolazine Versus Amiodarone for Prevention of Postoperative Atrial Fibrillation

Abstract

Evaluation of: Miles RH, Passman R, Murdock DK. Comparison of effectiveness and safety of ranolazine versus amiodarone for preventing atrial fibrillation after coronary artery bypass grafting. Am. J. Cardiol. 108(5), 673–676 (2011). Postoperative atrial fibrillation (AF) is a major complication of cardiothoracic surgery, leading to significant consequences, including a higher rate of stroke, longer hospital stays and increased costs. Amiodarone is among the most widely used agents for prevention of postoperative AF. Ranolazine, a US FDA-approved antianginal agent, has been shown to effectively, safely prevent and terminate nonpostoperative AF in both experimental and clinical studies. In a recent publication, Miles and colleagues directly compared the efficacy and safety of amiodarone and ranolazine for prevention of postoperative AF in 393 patients. The patients were pretreated with amiodarone and ranolaizne for >1 week and 1 day, respectively, and the treatment continued for 10–14 days after surgery. Following coronary artery bypass grafting (CABG), AF occurred in 26.5% of patients taking amiodarone and in 17.5% of patients taking ranolazine (34% reduction; p < 0.035). No differences in adverse events between the two groups of patients were recorded. The results of this retrospective nonrandomized single-center study indicate that ranolazine may be used to effectively and safely prevent postoperative AF. These results need to be confirmed in a larger randomized study. If confirmed, ranolazine may be a good choice for preventing AF in patients undergoing CABG.

Keywords:

• antiarrhythmic drugs
• cardiac arrhythmias
• electrophysiology
• pharmacology
• sodium channel blockers

Financial & competing interests disclosure

Charles Antzelevitch is a consultant for Gilead Sciences and AstraZeneca and has received research grant support from Gilead Sciences, AstraZeneca, Merck, Cardiome and Buchang Group over the past 24 months. Support was also recieved from the NHLBI (grant HL47678) and the Masons of New York State and Florida. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.