Ranolazine for rhythm control in atrial fibrillation: A systematic review and meta-analysis

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• 作者：Federico Guerra^a ; ^{f.guerra@univpm.it} ; Andrea Romandini^a ; Alessandro Barbarossa^a ; Luiz Belardinelli^b ; Alessandro Capucci^a
• 关键词：Anti-arrhythmic drug ; Atrial fibrillation ; Cardioversion ; Meta-analysis ; Ranolazine ; Rhythm control
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：284-291
• 全文大小：968 K
• 卷排序：227

文摘

Available pharmacological options for rhythm control strategy in atrial fibrillation (AF) are limited by sub-optimal efficacy and potentially serious adverse events. The aim of the present meta-analysis is to determine the efficacy and safety of ranolazine for AF management.MethodsThe present meta-analysis was conducted according to current recommendations (CRD42016039000). Two large medical databases (MEDLINE and Scopus) were systematically searched and from that eight randomized clinical trials and two non-randomized observational studies were identified. The primary endpoint was to determine the efficacy of ranolazine to prevent AF episodes. Secondary efficacy endpoints were: efficacy in converting AF to sinus rhythm, time to conversion, and reduction in AF burden. Safety endpoints included death, serious adverse events, and QTc prolongation.ResultsRanolazine was found to be 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 showed a larger effect size in post-operative AF (OR 0.29; 95% CI 0.11–0.77; p = 0.03) when compared to no post-operative AF (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 (SMD − 2.83 h; 95% CI − 4.69 – − 0.97 h; p < 0.001). Overall risks of death, adverse events, and QTc prolongation were comparable between ranolazine and control group.ConclusionsRanolazine is an effective option when used for rhythm control strategy in AF. The use of ranolazine seems to be safe and associated with few adverse events.