USA: Ranolazine is effective in reducing ventricular tachyarrhythmia (VTA) burden among high-risk patients without the concomitant use of antiarrhythmic drugs (AADs), without atrial fibrillation, and/or with cardiac resynchronization therapy-defibrillator (CRT-D) -- shows a recent study. Ranolazine addition however did not affect vta burden in patients already on AADs or those with AF. The study appears in JACC: Clinical Electrophysiology.

Ranolazine treatment was shown to be associated with the reduction in recurrent ventricular tachycardia requiring suitable implantable cardioverter-defibrillator (ICD) therapy. Arwa Younis, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA, and colleagues aimed to identify groups of patients in whom ranolazine treatment would result in the highest reduction of VTA burden.
For this purpose, the researchers performed Andersen-Gill analyses to identify variables associated with the risk of VTA burden among 1,012 patients enrolled in RAID. VTA burden defined as VTA episodes requiring appropriate treatment was the primary endpoint.
The researchers reported the following findings:
Multivariate analysis identified 7 factors associated with increased VTA burden: history of VTA, age ≥65 years, New York Heart Association functional class ≥III, QRS complex (≥130 ms), low ejection fraction (<30%), atrial fibrillation (AF), and concomitant antiarrhythmic drug (AAD) therapy.
The effect of ranolazine on VTA burden was seen among patients without concomitant AAD therapy (HR [HR]: 0.68), whereas no effect was seen among those who are concomitantly treated with other AADs (HR: 1.33).
In patients with cardiac resynchronization therapy (CRT) ICDs, ranolazine treatment was associated with a 36% risk reduction for VTA recurrence (HR: 0.64), whereas among patients with ICDs without CRT no significant effect was noted (HR: 0.94).
Among high-risk HF patients implanted with defibrillators, predictors of increased ventricular tachyarrhythmia burden include a history of VTA, age ≥65 years, QRS duration (≥130 ms), NYHA functional class ≥III, AF, low LVEF (<30%), and the use of AADs.
"Ranolazine treatment is effective in reducing the burden of ventricular tachyarrhythmia among cardiac resynchronization therapy patients, those without AF, or as single antiarrhythmic drugs (AADs) therapy," wrote the authors. In patients already on AADs, or AF patients, ranolazine addition does not result in a favorable effect on first or recurrent VTA."
Reference:
The study titled, "Reduction in Ventricular Tachyarrhythmia Burden in Patients Enrolled in the RAID Trial," appears in the journal JACC: Clinical Electrophysiology.
DOI: 10.1016/j.jacep.2022.02.018