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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Ranolazine as you have never seen it before: an antiarrhythmic for atrial fibrillation
Session:
Painel 5 -Arritmologia 2
Speaker:
José Pedro Sousa
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
José Pedro Sousa; Luís Puga; Joana M. Ribeiro; João Gameiro; Carolina Saleiro; Ana Rita M. Gomes; Diana Decampos; Carolina Lourenço; Lino Gonçalves
Abstract
<p>Background: Currently available pharmacological options for rhythm control in atrial fibrillation (AF) are overshadowed by suboptimal efficacy and both frequent and potentially severe adverse events. Recent studies have added evidence to the hypothesis that ranolazine might exert antiarrhythmic effects, particularly in atrial tachyarrhythmias.</p> <p>Purpose: To perform a systematic review with meta-analysis in order to ascertain the potential role of ranolazine in the management of AF.</p> <p>Methods: We systematically searched MEDLINE, Embase and Scopus for randomized controlled trials (RCTs) and cohort studies addressing the association between ranolazine and AF outcomes, published up until December 1, 2019. The primary endpoint was incidence of AF, which was evaluated under a ranolazine versus placebo design. In this regard, patients in the setting of post-cardiac surgery were further investigated separately. Secondary endpoints included AF cardioversion outcomes, which were addressed through comparison between ranolazine plus amiodarone and amiodarone alone for proportional efficacy and temporal requirements (time-to-cardioversion). The latter analysis was also undertaken in a dose-sensitive fashion (≤1000mg vs. 1500mg of ranolazine). Tertiary endpoints covered AF burden and episodes, in paroxysmal AF patients, and safety outcomes, namely death, QTc interval prolongation and hypotension. Study-speci?c odds ratios (ORs) were pooled using meta-analytic techniques with a random-effects model.</p> <p>Results: A total of 10 RCTs comprising 8.109 participants and 3 cohort studies encompassing 37.112 patients were regarded as eligible for evaluation. Ranolazine was found to attenuate patients’ odds of developing AF (OR 0.53, 95% CI 0.41-0.69, p<0.001, i<sup>2</sup>=58%). This effect held true, with an even larger effect size, in the context of post-cardiac surgery (OR 0.34, 95% CI 0.16-0.72, p=0.005, i<sup>2</sup>=64%). Ranolazine increased the chances of successful AF cardioversion when added to amiodarone over amiodarone alone (OR 6.67, 95% CI 1.49-29.89, p=0.01, i<sup>2</sup>=76%), while significantly reducing time-to-cardioversion [SMD -9.54h, 95% CI -13.3--5.75, p<0.001, i<sup>2</sup>=99%]. Interestingly, cardioversion was faster with ≤1000mg of ranolazine (SMD -13.16h, 95% CI -15.07--11.25, p<0.001, i<sup>2</sup>=95%) than with 1500mg (SMD -3.57h, 95% CI -5.06--2.08, p<0.001, i<sup>2</sup>=23%). In paroxysmal AF, ranolazine was also proved to significantly reduce both AF burden and episodes. There were no safety signals regarding mortality odds, QTc interval prolongation (mostly clinically insignificant) and hypotension (mostly transitory).</p> <p>Conclusion: Current evidence suggests that ranolazine provides an effective and safe option for a chemical rhythm control strategy in AF management, a field in which medical breakthroughs are desperately needed.</p>
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