Abstract
Background: Ranolazine has the potential to prevent atrial fibrillation (AF) and plays a role in rhythm control strategy for atrial fibrillation in various clinical settings. However, data on the use of ranolazine in patients with left ventricular (LV) systolic dysfunction are limited. The aims of this meta-analysis of randomized clinical trials are to investigate the efficacy and safety of ranolazine in AF patients with LV systolic dysfunction. PubMed and the Cochrane Database of Systematic Reviews were searched until July 2020. The efficacy outcomes included the incidence of new-onset AF, the rate of sinus rhythm restoration, and the time until sinus rhythm restoration. Safety endpoints were at death, and any adverse events were reported in the enrolled studies. We initially identified 204 studies and finally retrieved 5 RCTs. Three studies were analyzed in the meta-analysis. Among AF patients with LV systolic dysfunction, our meta-analysis showed that the combination of ranolazine to amiodarone significantly increased the sinus rhythm restoration rate compared to amiodarone alone (risk ratio (RR) 2.87, 95% confidence interval (CI) 2.48–3.32). Moreover, the time to sinus rhythm restoration was 2.46 h shorter in the ranolazine added to amiodarone group (95% CI: 2.27–2.64). No significant adverse events and proarrhythmias in the ranolazine group were identified. In conclusion, in AF patients with LV systolic dysfunction, ranolazine as an add-on therapy to amiodarone potentiates and accelerates the conversion of AF to sinus rhythm. Moreover, ranolazine shows good safety profiles. Further studies to investigate the effectiveness of ranolazine in the prevention of new-onset AF among patients with LV systolic dysfunction are needed.
Highlights
For patients with atrial fibrillation (AF) and left ventricular (LV) systolic dysfunction, most of the recent studies favor rhythm control, especially by catheter ablation over rate control [1,2,3]
The purpose of this study was to conduct a comprehensive meta-analysis of all published randomized controlled trials (RCTs) that investigated the efficacy and safety of ranolazine, either being used as a single drug or as an adjunctive therapy in patients with AF and LV systolic dysfunction
Among the 5 RCTs which were enrolled for a qualitative review, 3 of them were further examined in meta-analysis for outcomes of interest, which included difference of time to sinus rhythm restoration and sinus rhythm restoration rate in AF patients with LV systolic dysfunction
Summary
For patients with atrial fibrillation (AF) and left ventricular (LV) systolic dysfunction, most of the recent studies favor rhythm control, especially by catheter ablation over rate control [1,2,3]. Ranolazine selectively inhibits the atrial peak sodium channel current (INa), resulting in increased atrial post-repolarization refractoriness, which may account for AF suppression [10,11] Previous studies support this hypothesis, demonstrating that ranolazine has the potential to prevent AF and convert it to sinus rhythm in various clinical settings [12,13,14]. The purpose of this study was to conduct a comprehensive meta-analysis of all published randomized controlled trials (RCTs) that investigated the efficacy and safety of ranolazine, either being used as a single drug or as an adjunctive therapy in patients with AF and LV systolic dysfunction. Data on the use of ranolazine in patients with left ventricular (LV) systolic dysfunction are limited The aims of this meta-analysis of randomized clinical trials are to investigate the efficacy and safety of ranolazine in AF patients with LV systolic dysfunction. Further studies to investigate the effectiveness of ranolazine in the prevention of new-onset AF among patients with LV systolic dysfunction are needed
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