1
|
Kaplan AD, Joca HC, Boyman L, Greiser M. Calcium Signaling Silencing in Atrial Fibrillation: Implications for Atrial Sodium Homeostasis. Int J Mol Sci 2021; 22:10513. [PMID: 34638854 PMCID: PMC8508839 DOI: 10.3390/ijms221910513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, affecting more than 33 million people worldwide. Despite important advances in therapy, AF's incidence remains high, and treatment often results in recurrence of the arrhythmia. A better understanding of the cellular and molecular changes that (1) trigger AF and (2) occur after the onset of AF will help to identify novel therapeutic targets. Over the past 20 years, a large body of research has shown that intracellular Ca2+ handling is dramatically altered in AF. While some of these changes are arrhythmogenic, other changes counteract cellular arrhythmogenic mechanisms (Calcium Signaling Silencing). The intracellular Na+ concentration ([Na+])i is a key regulator of intracellular Ca2+ handling in cardiac myocytes. Despite its importance in the regulation of intracellular Ca2+ handling, little is known about [Na+]i, its regulation, and how it might be changed in AF. Previous work suggests that there might be increases in the late component of the atrial Na+ current (INa,L) in AF, suggesting that [Na+]i levels might be high in AF. Indeed, a pharmacological blockade of INa,L has been suggested as a treatment for AF. Here, we review calcium signaling silencing and changes in intracellular Na+ homeostasis during AF. We summarize the proposed arrhythmogenic mechanisms associated with increases in INa,L during AF and discuss the evidence from clinical trials that have tested the pharmacological INa,L blocker ranolazine in the treatment of AF.
Collapse
Affiliation(s)
- Aaron D. Kaplan
- Center for Biomedical Engineering and Technology, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.D.K.); (H.C.J.); (L.B.)
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Humberto C. Joca
- Center for Biomedical Engineering and Technology, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.D.K.); (H.C.J.); (L.B.)
| | - Liron Boyman
- Center for Biomedical Engineering and Technology, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.D.K.); (H.C.J.); (L.B.)
| | - Maura Greiser
- Center for Biomedical Engineering and Technology, Department of Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.D.K.); (H.C.J.); (L.B.)
| |
Collapse
|
2
|
Nabeh OA, Helaly MM, Menshawey R, Menshawey E, Nasser MMM, Diaa El-deen AM. Contemporary approach to understand and manage COVID-19-related arrhythmia. Egypt Heart J 2021; 73:76. [PMID: 34459992 PMCID: PMC8403826 DOI: 10.1186/s43044-021-00201-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
Arrhythmia, one of the most common complications of COVID-19, was reported in nearly one-third of diagnosed COVID-19 patients, with higher prevalence rate among ICU admitted patients. The underlying etiology for arrhythmia in these cases are mostly multifactorial as those patients may suffer from one or more of the following predisposing mechanisms; catecholamine surge, hypoxia, myocarditis, cytokine storm, QTc prolongation, electrolyte disturbance, and pro-arrhythmic drugs usage. Obviously, the risk for arrhythmia and the associated lethal outcome would rise dramatically among patients with preexisting cardiac disease such as myocardial ischemia, heart failure, cardiomyopathy, and hereditary arrhythmias. Considering all of these variables, the management strategy of COVID-19 patients should expand from managing a viral infection and related host immune response to include the prevention of predictable causes for arrhythmia. This may necessitate the need to investigate the role of some drugs that modulate the pathway of arrhythmia generation. Of these drugs, we discuss the potential role of adrenergic antagonists, trimetazidine, ranolazine, and the debatable angiotensin converting enzyme inhibitors drugs. We also recommend monitoring the level of: unbound free fatty acids, serum electrolytes, troponin, and QTc (even in the absence of apparent pro-arrhythmic drug use) as these may be the only indicators for patients at risk for arrhythmic complications.
Collapse
Affiliation(s)
- Omnia Azmy Nabeh
- Department of Medical Pharmacology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maiada Mohamed Helaly
- Department of Medical Pharmacology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rahma Menshawey
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esraa Menshawey
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | |
Collapse
|
3
|
Akcay M, Coksevim M, Yenercag M. Effect of ranolazine on Tp-e interval, Tp-e/QTc, and P-wave dispersion in patients with stable coronary artery disease. J Arrhythm 2021; 37:1015-1022. [PMID: 34386127 PMCID: PMC8339098 DOI: 10.1002/joa3.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Ranolazine is an antianginal drug and also exhibits antiarrhythmic effect by affecting action potential time, refractory period, and repolarization reserve. We evaluated the effect of ranolazine therapy on myocardial repolarization parameters (Tp-e, QT, QTc intervals, Tp-e/QT, and Tp-e/QTc ratios), index of cardiac electrophysiological balance (iCEB) (QT/QRS, QTc/QRS) and P-wave dispersion (PWD) in patients with stable coronary artery disease (CAD). METHODS This study included 175 patients, aged between 35 and 90 years who were followed with stable CAD for at least 3 months. Ninety patients had been receiving ranolazine for at least 1 month, and 85 patients had never received ranolazine. All patients' basic demographic data, risk factors, medications, and echocardiographic parameters recorded. Myocardial repolarization parameters, P-wave times, and PWD were analyzed from 12 lead electrodes. RESULTS There was no variation between the groups in terms of basic demographic parameters and CAD risk factors. Tp-e interval (87.3 ± 14.4 vs. 90.8 ± 12.4 msn, P < .001), Tp-e/QT (0.22 ± 0.04 vs. 0.23 ± 0.03; P = .03), Tp-e/QTc (0.21 ± 0.04 vs. 0.22 ± 0.04 P = .001), and PWD (39.2 ± 13.7 vs. 43.5 ± 12.9 P = .028) were significantly lower in the ranolazine group. But iCEB was similar in both groups. In multivariate analysis after adjusted confounding factors such as age and BMI, Tp-e/QTc ratio, QTc, Pmax, and PWD were found significantly in ranolazine group again. CONCLUSION Tp-e/QTc ratio, QTc, Pmax, and PWD were significantly lower in stable CAD patients under ranolazine therapy. In stable CAD patients, the prognostic significance of ranolazine for arrhythmic events requires further evaluation of these parameters through long-term follow-up and large-scale prospective studies.
Collapse
Affiliation(s)
- Murat Akcay
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
| | - Metin Coksevim
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
| | - Mustafa Yenercag
- Department of CardiologyFaculty of MedicineOrdu UniversityOrduTurkey
| |
Collapse
|
4
|
Chukwunyere U, Sehirli AO, Abacioglu N. COVID-19-related arrhythmias and the possible effects of ranolazine. Med Hypotheses 2021; 149:110545. [PMID: 33636586 PMCID: PMC7890340 DOI: 10.1016/j.mehy.2021.110545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
The COVID-19 pandemic has become a burden to the global healthcare community. Despite the severity of the complications associated with COVID-19, no antiviral agent is yet available for the treatment of this disease. Several studies have reported arrhythmias as one of the numerous manifestations associated with COVID-19 infection. Clinicians use different therapeutic agents in the management of COVID-19 patients with arrhythmias, apart from ranolazine; however, some of these drugs are administered with caution because of their significant side effects. In this study, we reviewed the potential antiarrhythmic effects of ranolazine in the management of cardiac arrhythmias associated with COVID-19. Ranolazine is a second-line drug approved for the treatment of chronic stable angina pectoris. Previous studies have shown that ranolazine produces its beneficial cardiac effects without any significant impact on the body’s hemodynamics; hence, blood pressure is not altered. Due to its reduced side effects, ranolazine may be more effective than other drugs in producing the desired relief from COVID-19 related arrhythmias, since it produces its antiarrhythmic effect by modulating sodium, potassium and calcium channels, and suppressing cytokine expression.
Collapse
Affiliation(s)
- Ugochukwu Chukwunyere
- Department of Pharmacology, Faculty of Pharmacy, Near East University, Nicosia, Cyprus.
| | - Ahmet Ozer Sehirli
- Department of Pharmacology, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Nurettin Abacioglu
- Department of Pharmacology, Faculty of Pharmacy, Near East University, Nicosia, Cyprus; Department of Pharmacology, Faculty of Pharmacy, Kyrenia University, Kyrenia, Cyprus
| |
Collapse
|
5
|
Reiffel JA, Capucci A. "Pill in the Pocket" Antiarrhythmic Drugs for Orally Administered Pharmacologic Cardioversion of Atrial Fibrillation. Am J Cardiol 2021; 140:55-61. [PMID: 33144165 DOI: 10.1016/j.amjcard.2020.10.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022]
Abstract
The therapy of atrial fibrillation often involves the use of a rhythm control strategy, in which 1 or more antiarrhythmic drugs (AAD), ablative procedures, and/or hybrid approaches involving both of these options are utilized in an attempt to restore and maintain sinus rhythm. For chronic therapy, an AAD is taken daily. However, for patients with symptomatic but infrequent, acute, but nondestabilizing episodes, the use of an AAD only at the time of an episode that can quickly restore sinus rhythm, generally as an out-patient, without the burden of a daily drug regimen, may be better. This is called "pill-in-the-pocket" therapy. This manuscript reviews the "pill-in-the-pocket" concept, traces its development from its origins using quinidine, to its expansion using class IC AADs, to the more recent investigation of ranolazine for this purpose. Who should get it, what it involves, its efficacy rates and concerns are all discussed.
Collapse
|
6
|
Caves RE, Carpenter A, Choisy SC, Clennell B, Cheng H, McNiff C, Mann B, Milnes JT, Hancox JC, James AF. Inhibition of voltage-gated Na + currents by eleclazine in rat atrial and ventricular myocytes. Heart Rhythm O2 2020; 1:206-214. [PMID: 32864638 PMCID: PMC7442036 DOI: 10.1016/j.hroo.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Atrial-ventricular differences in voltage-gated Na+ currents might be exploited for atrial-selective antiarrhythmic drug action for the suppression of atrial fibrillation without risk of ventricular tachyarrhythmia. Eleclazine (GS-6615) is a putative antiarrhythmic drug with properties similar to the prototypical atrial-selective Na+ channel blocker ranolazine that has been shown to be safe and well tolerated in patients. Objective The present study investigated atrial-ventricular differences in the biophysical properties and inhibition by eleclazine of voltage-gated Na+ currents. Methods The fast and late components of whole-cell voltage-gated Na+ currents (respectively, INa and INaL) were recorded at room temperature (∼22°C) from rat isolated atrial and ventricular myocytes. Results Atrial INa activated at command potentials ∼5.5 mV more negative and inactivated at conditioning potentials ∼7 mV more negative than ventricular INa. There was no difference between atrial and ventricular myocytes in the eleclazine inhibition of INaL activated by 3 nM ATX-II (IC50s ∼200 nM). Eleclazine (10 μM) inhibited INa in atrial and ventricular myocytes in a use-dependent manner consistent with preferential activated state block. Eleclazine produced voltage-dependent instantaneous inhibition in atrial and ventricular myocytes; it caused a negative shift in voltage of half-maximal inactivation and slowed the recovery of INa from inactivation in both cell types. Conclusions Differences exist between rat atrial and ventricular myocytes in the biophysical properties of INa. The more negative voltage dependence of INa activation/inactivation in atrial myocytes underlies differences between the 2 cell types in the voltage dependence of instantaneous inhibition by eleclazine. Eleclazine warrants further investigation as an atrial-selective antiarrhythmic drug.
Collapse
Affiliation(s)
- Rachel E Caves
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Alexander Carpenter
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Stéphanie C Choisy
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Ben Clennell
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Hongwei Cheng
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Cameron McNiff
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Brendan Mann
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | | | - Jules C Hancox
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Andrew F James
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
7
|
Utility of Amiodarone Pre-Treatment as a Facilitator of the Acute Success of Electrical Cardioversion in Persistent Atrial Fibrillation. Cardiovasc Drugs Ther 2020; 34:89-94. [PMID: 32096001 DOI: 10.1007/s10557-019-06934-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The usefulness and mechanisms of antiarrhythmic drug (AAD) pre-treatment as a facilitator of the acute success of electrical cardioversion (ECV) in atrial fibrillation (AF) remain controversial. We sought to analyze the role of AAD treatment with this purpose, differentiating its possible utility either facilitating the restoration of sinus rhythm (SR) or reducing immediate AF recurrences (IAFR). METHODS We analyzed 2962 consecutive patients with persistent AF undergoing ECV prospectively included in 3 national registries. The acute success of ECV was indicated by the reversion to SR without presenting an IAFR (< 2 h). RESULTS A total of 1410 patients (48%) received AAD treatment prior to ECV (80% amiodarone, 15% class Ic AAD, 2% other AAD). The rate of restoration of SR was similar between the patients treated with amiodarone (92%), class Ic AAD (91%) and who did not receive AAD pre-treatment (91%) (p = 0.92). However, those treated with amiodarone had fewer IAFR than those in the other two groups (amiodarone 3% vs class Ic 7% vs without treatment 6%; p = 0.002), so the ECV success rate was higher in the amiodarone group than in the other groups (amiodarone 89% vs Ic 84% vs without treatment 86%; p = 0.04). After adjusting for multiple variables, amiodarone remained as an independent predictor of a lower occurrence of IAFR (OR = 0.57; p = 0.01) and of a successful ECV (OR 1.37; p = 0.01). CONCLUSIONS For patients with persistent AF undergoing ECV, AAD has a neutral effect on the restoration of SR but amiodarone increases its effectiveness due to a lower incidence of IAFR.
Collapse
|
8
|
Mezincescu A, Karthikeyan VJ, Nadar SK. Ranolazine: A true pluripotent cardiovascular drug or jack of all trades, master of none? Sultan Qaboos Univ Med J 2018; 18:e13-e23. [PMID: 29666676 DOI: 10.18295/squmj.2018.18.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/18/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Although the majority of patients with CVD are treated with interventional procedures, a substantial number require medical therapy in terms of both prognosis and symptomatic relief. However, commonly used agents such as β-blockers and calcium channel blockers reduce blood pressure in patients whose resting pressures are often already low. Ranolazine is a promising agent that does not have significant effects on blood pressure or heart rate. Use of this drug has been documented in various cardiovascular conditions, including ischaemic heart disease, heart failure and arrhythmias. This review article aimed to examine current evidence on the use of ranolazine in various cardiovascular conditions in order to determine whether it is a true pluripotent cardiovascular agent or, on the other hand, a "jack of all trades, master of none."
Collapse
Affiliation(s)
- Alice Mezincescu
- Cardiovascular & Diabetes Research Unit, University of Aberdeen, Aberdeen, UK
| | - V J Karthikeyan
- Royal Albert Edward Infirmary, Wrightington Wigan & Leigh NHS Foundation Trust, Wigan, UK
| | - Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| |
Collapse
|
9
|
Margos P, Margos N, Mokadem N, Patsiotis I, Kranidis A. Ranolazine: safe and effective in a patient with hypertensive cardiomyopathy and multiple episodes of electrical storm. Clin Case Rep 2017; 5:1170-1175. [PMID: 28680620 PMCID: PMC5494397 DOI: 10.1002/ccr3.1019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/11/2017] [Accepted: 04/09/2017] [Indexed: 12/19/2022] Open
Abstract
Among implantable cardioverter-defibrillator (ICD) recipients, there are patients with recurrent episodes of electrical storm (ES), retractable to the optimal antiarrhythmic drug therapy or invasive ablation procedures. A relatively novel anti-ischemic drug with also antiarrhythmic properties, ranolazine, may effectively suppress ventricular arrhythmias in such patients for a long period of time.
Collapse
Affiliation(s)
- Panagiotis Margos
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| | - Nikolaos Margos
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| | - Nadiya Mokadem
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| | - Ilias Patsiotis
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| | - Athanasios Kranidis
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| |
Collapse
|
10
|
Atrial-ventricular differences in rabbit cardiac voltage-gated Na + currents: Basis for atrial-selective block by ranolazine. Heart Rhythm 2017; 14:1657-1664. [PMID: 28610990 PMCID: PMC5666337 DOI: 10.1016/j.hrthm.2017.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Indexed: 01/15/2023]
Abstract
Background Class 1 antiarrhythmic drugs are highly effective in restoring and maintaining sinus rhythm in atrial fibrillation patients but carry a risk of ventricular tachyarrhythmia. The antianginal agent ranolazine is a prototypic atrial-selective voltage-gated Na+ channel blocker but the mechanisms underlying its atrial-selective action remain unclear. Objective The present study examined the mechanisms underlying the atrial-selective action of ranolazine. Methods Whole-cell voltage-gated Na+ currents (INa) were recorded at room temperature (∼22°C) from rabbit isolated left atrial and right ventricular myocytes. Results INa conductance density was ∼1.8-fold greater in atrial than in ventricular cells. Atrial INa was activated at command potentials ∼7 mV more negative and inactivated at conditioning potentials ∼11 mV more negative than ventricular INa. The onset of inactivation of INa was faster in atrial cells than in ventricular myocytes. Ranolazine (30 μM) inhibited INa in atrial and ventricular myocytes in a use-dependent manner consistent with preferential activated/inactivated state block. Ranolazine caused a significantly greater negative shift in voltage of half-maximal inactivation in atrial cells than in ventricular cells, the recovery from inactivation of INa was slowed by ranolazine to a greater extent in atrial myocytes than in ventricular cells, and ranolazine produced an instantaneous block that showed marked voltage dependence in atrial cells. Conclusion Differences exist between rabbit atrial and ventricular myocytes in the biophysical properties of INa. The more negative voltage dependence of INa activation and inactivation, together with trapping of the drug in the inactivated channel, underlies an atrial-selective action of ranolazine.
Collapse
|
11
|
TSANAXIDIS NIKOS, AIDONIDIS ISAAC, HATZIEFTHIMIOU APOSTOLIA, DASKALOPOULOU STELLAS, GIAMOUZIS GRIGORIOS, TRIPOSKIADIS FILIPPOS, SKOULARIGIS IOANNIS. Ranolazine Added to Amiodarone Facilitates Earlier Conversion of Atrial Fibrillation Compared to Amiodarone-Only Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:372-378. [DOI: 10.1111/pace.13048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 01/05/2023]
Affiliation(s)
- NIKOS TSANAXIDIS
- Department of Cardiology at University Hospital of Larissa; Larissa Greece
| | - ISAAC AIDONIDIS
- Department of Physiology, Medical School of Larissa; University of Thessaly; Larissa Greece
| | | | - STELLA S. DASKALOPOULOU
- Division of Internal Medicine and Experimental Medicine, Department of Medicine; McGill University Health Centre; Canada
| | | | | | | |
Collapse
|
12
|
Guerra F, Romandini A, Barbarossa A, Belardinelli L, Capucci A. Ranolazine for rhythm control in atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2017; 227:284-291. [DOI: 10.1016/j.ijcard.2016.11.103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/06/2016] [Indexed: 12/19/2022]
|
13
|
Pulford BR, Kluger J. Ranolazine Therapy in Cardiac Arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1006-15. [PMID: 27358212 DOI: 10.1111/pace.12905] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 12/19/2022]
Abstract
Ranolazine is an antianginal medication originally granted approval by the U.S. Food and Drug Administration for therapeutic use in 2006. Since its introduction into the U.S. market, there have been multiple trials and clinical case reports that demonstrate ranolazine may be effective in the prevention and treatment of both atrial and ventricular arrhythmias, including postoperative atrial fibrillation following coronary artery bypass graft (CABG) surgery. More recently, the combination of dronedarone with ranolazine has demonstrated in initial studies to have a synergistic effect in the reduction of burden of atrial fibrillation. This article will review the basic pharmacology of ranolazine, the studies demonstrating use of ranolazine in atrial and ventricular arrhythmias, the limitations to the use of ranolazine as antiarrhythmic therapy, and explore the synergistic effect with other agents in the suppression of arrhythmias.
Collapse
Affiliation(s)
- Brian R Pulford
- Department of Medicine, University of Connecticut School of Medicine.
| | | |
Collapse
|
14
|
Abstract
INTRODUCTION Over the last decade, tremendous progress has been made in defining the genetic architecture of atrial fibrillation (AF). This has in part been driven by poor understanding of the pathophysiology of AF, limitations of current therapies and failure to target therapies to the underlying mechanisms. AREAS COVERED Genetic approaches to AF have identified mutations encoding cardiac ion channels, and signaling proteins linked with AF and genome-wide association studies have uncovered common genetic variants modulating AF risk. These studies have provided important insights into the underlying mechanisms of AF and defined responses to therapies. Common AF-risk alleles at the chromosome 4q25 locus modulate response to antiarrhythmic drugs, electrical cardioversion and catheter ablation. While the translation of these discoveries to the bedside care of individual patients has been limited, emerging evidence supports the hypothesis that genotype-directed approaches that target the underlying mechanisms of AF may not only improve therapeutic efficacy but also minimize adverse effects. Expert commentary: There is an urgent need for randomized controlled trials that are genotype-based for the treatment of AF. Nonetheless, emerging data suggest that selecting therapies for AF that are genotype-directed may soon be upon us.
Collapse
Affiliation(s)
- Henry Huang
- a Division of Cardiology, Department of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - Dawood Darbar
- a Division of Cardiology, Department of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| |
Collapse
|
15
|
Shenasa M, Assadi H, Heidary S, Shenasa H. Ranolazine: Electrophysiologic Effect, Efficacy, and Safety in Patients with Cardiac Arrhythmias. Card Electrophysiol Clin 2016; 8:467-479. [PMID: 27261835 DOI: 10.1016/j.ccep.2016.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Ranolazine is currently approved as an antianginal agent in patients with chronic angina (class IIA). Ranolazine exhibits antiarrhythmic effects that are related to its multichannel blocking effect, predominantly inhibition of late sodium (late INa) current and the rapid potassium rectifier current (IKr), as well as ICa, late ICa, and INa-Ca. It also suppresses the early and delayed after depolarizations. Ranolazine is effective in the suppression of atrial and ventricular arrhythmias (off-label use) without significant proarrhythmic effect. Currently, ongoing trials are evaluating the efficacy and safety of ranolazine in patients with cardiac arrhythmias; preliminary results suggest that ranolazine, when used alone or in combination with dronedarone, is safe and effective in reducing atrial fibrillation. Ranolazine is not currently approved by the US Food and Drug Administration as an antiarrhythmic agent.
Collapse
Affiliation(s)
- Mohammad Shenasa
- Heart and Rhythm Medical Group, Department of Cardiovascular Services, O'Connor Hospital, 105 North Bascom Avenue, San Jose, CA 95128, USA.
| | - Hamid Assadi
- Heart and Rhythm Medical Group, Department of Cardiovascular Services, O'Connor Hospital, 105 North Bascom Avenue, San Jose, CA 95128, USA
| | - Shahriar Heidary
- Heart and Rhythm Medical Group, Department of Cardiovascular Services, O'Connor Hospital, 105 North Bascom Avenue, San Jose, CA 95128, USA
| | - Hossein Shenasa
- Heart and Rhythm Medical Group, Department of Cardiovascular Services, O'Connor Hospital, 105 North Bascom Avenue, San Jose, CA 95128, USA
| |
Collapse
|
16
|
Hancox JC, James AF, Marrion NV, Zhang H, Thomas D. Novel ion channel targets in atrial fibrillation. Expert Opin Ther Targets 2016; 20:947-58. [DOI: 10.1517/14728222.2016.1159300] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Jules C. Hancox
- School of Physiology, Pharmacology and Neuroscience, University Walk, Bristol, UK
| | - Andrew F. James
- School of Physiology, Pharmacology and Neuroscience, University Walk, Bristol, UK
| | - Neil V. Marrion
- School of Physiology, Pharmacology and Neuroscience, University Walk, Bristol, UK
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Dierk Thomas
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
17
|
Affiliation(s)
| | - Tara Sedlak
- University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
18
|
Mihos CG, Krishna RK, Kherada N, Larrauri-Reyes M, Tolentino A, Santana O. The use of ranolazine in non-anginal cardiovascular disorders: A review of current data and ongoing randomized clinical trials. Pharmacol Res 2015; 103:49-55. [PMID: 26546970 DOI: 10.1016/j.phrs.2015.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/05/2015] [Accepted: 10/23/2015] [Indexed: 12/19/2022]
Abstract
Ranolazine has characteristic properties of a selective inhibitor of the inward sodium current. It is primarily indicated as an anti-anginal agent in patients with coronary artery disease and chronic stable angina. Recently, ranolazine has been noted to possibly impart beneficial effects in various other cardiac conditions, including new-onset, paroxysmal, and chronic atrial fibrillation, post-operative atrial fibrillation, ventricular arrhythmias, post-revascularization coronary artery disease, chemotherapeutic cardiotoxicity, and diastolic and microvascular dysfunction. Herein, we present a review of the current clinical evidence describing the adjunctive or synergistic effects of ranolazine in non-angina related cardiovascular disorders, and include a discussion of the ongoing randomized trials investigating the therapeutic potential of ranolazine in a variety of cardiovascular diseases.
Collapse
Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rama K Krishna
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, United States
| | - Nisharahmed Kherada
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, United States
| | - Maiteder Larrauri-Reyes
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, United States
| | - Alfonso Tolentino
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, United States
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, United States.
| |
Collapse
|
19
|
CARNEIRO JULIANASARAN, BENTO AFONSOSALVES, BACIC DANILO, NEARING BRUCED, RAJAMANI SRIDHARAN, BELARDINELLI LUIZ, VERRIER RICHARDL. The Selective Cardiac Late Sodium Current Inhibitor GS-458967 Suppresses Autonomically Triggered Atrial Fibrillation in an Intact Porcine Model. J Cardiovasc Electrophysiol 2015; 26:1364-9. [DOI: 10.1111/jce.12824] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 12/19/2022]
Affiliation(s)
- JULIANA SARAN CARNEIRO
- Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - AFONSO S. ALVES BENTO
- Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - DANILO BACIC
- Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - BRUCE D. NEARING
- Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Harvard Medical School; Boston Massachusetts USA
| | | | | | - RICHARD L. VERRIER
- Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Harvard Medical School; Boston Massachusetts USA
| |
Collapse
|
20
|
Saad M, Mahmoud A, Elgendy IY, Richard Conti C. Ranolazine in Cardiac Arrhythmia. Clin Cardiol 2015; 39:170-8. [PMID: 26459200 DOI: 10.1002/clc.22476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 12/19/2022] Open
Abstract
Ranolazine utilization in the management of refractory angina has been established by multiple randomized clinical studies. However, there is growing evidence showing an evolving role in the field of cardiac arrhythmias. Multiple experimental and clinical studies have evaluated the role of ranolazine in prevention and management of atrial fibrillation, with ongoing studies on its role in ventricular arrhythmias. In this review, we will discuss the pharmacological, experimental, and clinical evidence behind ranolazine use in the management of various cardiac arrhythmias.
Collapse
Affiliation(s)
- Marwan Saad
- Department of Medicine, Seton Hall University School of Health and Medical Sciences, Trinitas Regional Medical Center, Elizabeth, New Jersey
| | - Ahmed Mahmoud
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - C Richard Conti
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
21
|
Veerman CC, Wilde AAM, Lodder EM. The cardiac sodium channel gene SCN5A and its gene product NaV1.5: Role in physiology and pathophysiology. Gene 2015; 573:177-87. [PMID: 26361848 DOI: 10.1016/j.gene.2015.08.062] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/31/2015] [Accepted: 08/27/2015] [Indexed: 12/18/2022]
Abstract
The gene SCN5A encodes the main cardiac sodium channel NaV1.5. This channel predominates the cardiac sodium current, INa, which underlies the fast upstroke of the cardiac action potential. As such, it plays a crucial role in cardiac electrophysiology. Over the last 60years a tremendous amount of knowledge regarding its function at the electrophysiological and molecular level has been acquired. Furthermore, genetic studies have shown that mutations in SCN5A are associated with multiple cardiac diseases (e.g. Brugada syndrome, Long QT syndrome, conduction disease and cardiomyopathy), while genetic variation in the general population has been associated with differences in cardiac conduction and risk of arrhythmia through genome wide association studies. In this review we aim to give an overview of the current knowledge (and the gaps therein) on SCN5A and NaV1.5.
Collapse
Affiliation(s)
- Christiaan C Veerman
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Elisabeth M Lodder
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
22
|
Müssigbrodt A, John S, Kosiuk J, Richter S, Hindricks G, Bollmann A. Vernakalant-facilitated electrical cardioversion: comparison of intravenous vernakalant and amiodarone for drug-enhanced electrical cardioversion of atrial fibrillation after failed electrical cardioversion. Europace 2015; 18:51-6. [PMID: 26056189 PMCID: PMC7108474 DOI: 10.1093/europace/euv194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/07/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Electrical cardioversion is one cornerstone for the rhythm control strategy of atrial fibrillation (AF), which is, however, hampered by immediate AF recurrence (IRAF) or failed electrical cardioversion (FECV). We aimed to investigate the potential role of vernakalant for facilitated electrical cardioversion in cardioversion-resistant AF. METHODS AND RESULTS The subjects of this study were 63 patients referred to the Heart Centre Leipzig between November 2011 and May 2014 for transthoracic electrical cardioversion of AF. All patients experienced after antiarrhythmic-naïve electrical cardioversion either IRAF (n = 44; 70%) or FECV (n = 19; 30%). After drug infusion, electrical cardioversion was successful in 66.7% of vernakalant-treated as opposed to 46.7% of amiodarone-treated patients (P = 0.109). Multivariate analysis revealed treatment with vernakalant (OR 0.057, 95% CI 0.006-0.540, P = 0.013), treatment with ACEI or ARB (OR 0.101, 95% CI 0.015-0.691 P = 0.019), and IRAF after initial CV (OR 0.047, 95% CI 0.004-0.498, P = 0.011) as predictors for successful, drug-facilitated electrical cardioversion. Subgroup analysis of 18 patients with previous AF ablation revealed a significantly higher success rate of electrical cardioversion after infusion of vernakalant than after infusion of amiodarone (66.7 vs. 11.1%, P = 0.016). CONCLUSION Vernakalant may therefore be considered as a useful agent for facilitated electrical cardioversion in cardioversion-resistant AF.
Collapse
Affiliation(s)
- Andreas Müssigbrodt
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Silke John
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Jedrzej Kosiuk
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Sergio Richter
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department for Electrophysiology, Heart Center, University Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| |
Collapse
|
23
|
Rosa GM, Dorighi U, Ferrero S, Brunacci M, Bertero G, Brunelli C. Ranolazine for the treatment of atrial fibrillation. Expert Opin Investig Drugs 2015; 24:825-36. [DOI: 10.1517/13543784.2015.1036984] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
24
|
Daniels JD, Hill JA. Funny and late: targeting currents governing heart rate in atrial fibrillation. J Cardiovasc Electrophysiol 2015; 26:336-8. [PMID: 25511517 PMCID: PMC4357534 DOI: 10.1111/jce.12597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- James D. Daniels
- Department of Internal Medicine (Cardiology), UT Southwestern Medical Center, Dallas, TX
| | - Joseph A. Hill
- Department of Internal Medicine (Cardiology), UT Southwestern Medical Center, Dallas, TX
- Department of Molecular Biology, UT Southwestern Medical Center, Dallas, TX
| |
Collapse
|
25
|
De Ferrari GM, Maier LS, Mont L, Schwartz PJ, Simonis G, Leschke M, Gronda E, Boriani G, Darius H, Guillamón Torán L, Savelieva I, Dusi V, Marchionni N, Quintana Rendón M, Schumacher K, Tonini G, Melani L, Giannelli S, Alberto Maggi C, Camm AJ. Ranolazine in the treatment of atrial fibrillation: Results of the dose-ranging RAFFAELLO (Ranolazine in Atrial Fibrillation Following An ELectricaL CardiOversion) study. Heart Rhythm 2015; 12:872-8. [PMID: 25602175 DOI: 10.1016/j.hrthm.2015.01.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Currently available antiarrhythmic agents for the treatment of atrial fibrillation (AF) have important limitations, leaving an unmet need for safe and effective therapy. Ranolazine is an approved antianginal agent with a favorable safety profile and electrophysiologic properties suggesting a potential role in the treatment of AF. OBJECTIVE The purpose of this study was to assess the safety and efficacy of ranolazine in the prevention of AF recurrence after successful electrical cardioversion and to ascertain the most appropriate dose of this agent. METHODS This prospective, multicenter, randomized, double-blind, placebo-control parallel group phase II dose-ranging trial randomized patients with persistent AF (7 days to 6 months) 2 hours after successful electrical cardioversion to placebo, or ranolazine 375 mg, 500 mg, or 750 mg bid. Patients were monitored daily by transtelephonic ECG. The primary end-point was the time to first AF recurrence. RESULTS Of 241 patients randomized, 238 took at least 1 drug dose. Ranolazine proved to be safe and tolerable. No dose of the drug significantly prolonged time to AF recurrence. AF recurred in 56.4%, 56.9%, 41.7%, and 39.7% of patients in the placebo, ranolazine 375 mg, ranolazine 500 mg, and ranolazine 750 mg groups, respectively. The reduction in overall AF recurrence in the combined 500-mg and 750-mg groups was of borderline significance compared to the placebo group (P = .053) and significant compared to 375-mg group (P = .035). CONCLUSION No dose of ranolazine significantly prolonged time to AF recurrence. However, the 500-mg and 750 mg-groups combined reduced AF recurrences, suggesting a possible role for this agent in the treatment of AF.
Collapse
Affiliation(s)
- Gaetano M De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy.
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lluís Mont
- Department of Cardiology, Thorax Institute Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Matthias Leschke
- Klinikum Esslingen GmbH, Abteilung Kardiologie, Esslingen, Germany
| | | | - Giuseppe Boriani
- Ospedale S. Orsola-Malpighi, Dipartimento di Cardiologia, Bologna, Italy
| | | | | | | | - Veronica Dusi
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia and University of Pavia, Italy
| | - Niccolò Marchionni
- Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Miguel Quintana Rendón
- The Karolinska Institute at Hospital de Torrevieja, Servicio de Cardiología, Alicante, Spain
| | - Kai Schumacher
- Menarini Research & Business Service GmbH, Berlin, Germany
| | | | - Lorenzo Melani
- Menarini Industrie Farmaceutiche Riunite s.r.l, Florence, Italy
| | | | | | - A John Camm
- St. George's University, London, United Kingdom
| | | |
Collapse
|
26
|
Scirica BM, Belardinelli L, Chaitman BR, Waks JW, Volo S, Karwatowska-Prokopczuk E, Murphy SA, Cheng ML, Braunwald E, Morrow DA. Effect of ranolazine on atrial fibrillation in patients with non-ST elevation acute coronary syndromes: observations from the MERLIN-TIMI 36 trial. Europace 2014; 17:32-7. [DOI: 10.1093/europace/euu217] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
27
|
Bhimani AA, Yasuda T, Sadrpour SA, Khrestian CM, Lee S, Zeng D, Belardinelli L, Waldo AL. Ranolazine terminates atrial flutter and fibrillation in a canine model. Heart Rhythm 2014; 11:1592-9. [DOI: 10.1016/j.hrthm.2014.05.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Indexed: 12/22/2022]
|
28
|
FRAGAKIS NIKOLAOS, KOSKINAS KONSTANTINOSC, VASSILIKOS VASSILIOS. Ranolazine as a Promising Treatment Option for Atrial Fibrillation: Electrophysiologic Mechanisms, Experimental Evidence, and Clinical Implications. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1412-20. [DOI: 10.1111/pace.12486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- NIKOLAOS FRAGAKIS
- Third Department of Cardiology; Hippokrateion Hospital; Aristotle University Medical School; Thessaloniki Greece
| | - KONSTANTINOS C. KOSKINAS
- Third Department of Cardiology; Hippokrateion Hospital; Aristotle University Medical School; Thessaloniki Greece
| | - VASSILIOS VASSILIKOS
- Third Department of Cardiology; Hippokrateion Hospital; Aristotle University Medical School; Thessaloniki Greece
| |
Collapse
|
29
|
Sossalla S, Sohns C, Seegers J, Lüthje L, Vollmann D, Zabel M. Ranolazine maintained sinus rhythm in a patient with refractory symptomatic atrial fibrillation. Cardiovasc Ther 2014. [PMID: 23205928 DOI: 10.1111/1755-5922.12017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report on a patient who was treated with several antiarrhythmic drugs as well as different ablation strategies. Nevertheless, symptomatic atrial fibrillation always recurred until an off-label use with ranolazine was started. We could demonstrate potent effects of ranolazine on atrial fibrillation in a "wash-in wash-out" situation. Although promising controlled studies are needed to investigate a potential role of ranolazine for the treatment of atrial fibrillation.
Collapse
Affiliation(s)
- Samuel Sossalla
- Department of Cardiology and Pneumology/Heart Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | | | | | | | | | | |
Collapse
|
30
|
Ranolazine inhibition of hERG potassium channels: drug-pore interactions and reduced potency against inactivation mutants. J Mol Cell Cardiol 2014; 74:220-30. [PMID: 24877995 PMCID: PMC4121676 DOI: 10.1016/j.yjmcc.2014.05.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 01/06/2023]
Abstract
The antianginal drug ranolazine, which combines inhibitory actions on rapid and sustained sodium currents with inhibition of the hERG/IKr potassium channel, shows promise as an antiarrhythmic agent. This study investigated the structural basis of hERG block by ranolazine, with lidocaine used as a low potency, structurally similar comparator. Recordings of hERG current (IhERG) were made from cell lines expressing wild-type (WT) or mutant hERG channels. Docking simulations were performed using homology models built on MthK and KvAP templates. In conventional voltage clamp, ranolazine inhibited IhERG with an IC50 of 8.03 μM; peak IhERG during ventricular action potential clamp was inhibited ~ 62% at 10 μM. The IC50 values for ranolazine inhibition of the S620T inactivation deficient and N588K attenuated inactivation mutants were respectively ~ 73-fold and ~ 15-fold that for WT IhERG. Mutations near the bottom of the selectivity filter (V625A, S624A, T623A) exhibited IC50s between ~ 8 and 19-fold that for WT IhERG, whilst the Y652A and F656A S6 mutations had IC50s ~ 22-fold and 53-fold WT controls. Low potency lidocaine was comparatively insensitive to both pore helix and S6 mutations, but was sensitive to direction of K+ flux and particularly to loss of inactivation, with an IC50 for S620T-hERG ~ 49-fold that for WT IhERG. Docking simulations indicated that the larger size of ranolazine gives it potential for a greater range of interactions with hERG pore side chains compared to lidocaine, in particular enabling interaction of its two aromatic groups with side chains of both Y652 and F656. The N588K mutation is responsible for the SQT1 variant of short QT syndrome and our data suggest that ranolazine is unlikely to be effective against IKr/hERG in SQT1 patients. hERG K+ channels regulate cardiac action potential repolarization. The molecular basis of hERG block by ranolazine and structurally related lidocaine was studied. S6 Y652A and F656A mutations affected greatly ranolazine but not lidocaine binding. T623 and S624 residues may directly interact with ranolazine but not lidocaine. N588K and S620T attenuated inactivation mutants had reduced sensitivity to both drugs.
Collapse
|
31
|
Abstract
Antiarrhythmic drugs are widely used, but are of modest efficacy and have important side effects. However, even with the advance of catheter ablation for atrial fibrillation and ventricular tachycardia, antiarrhythmic drugs remain an important tool for treating arrhythmias. Antiarrhythmic drug development has remained slow despite much effort given our limited understanding of what role various ionic currents play in arrhythmogenesis and how they are modified by arrhythmias. This review will focus on promising new antiarrhythmic drugs undergoing clinical investigation or currently approved for clinical use, including amiodarone analogues, agents with novel ionic targets, and new drug combinations.
Collapse
Affiliation(s)
- Kapil Kumar
- Harvard Vanguard Medical Associates, 133 Brookline Avenue, Boston, MA 02215, USA.
| | | |
Collapse
|
32
|
Dagres N, Iliodromitis EK, Lekakis JP, Simitsis P, Karatzas D, Rallidis LS, Simeonidou E, Anastasiou-Nana M. Ranolazine for the prevention or treatment of atrial fibrillation. J Cardiovasc Med (Hagerstown) 2014; 15:254-9. [DOI: 10.2459/jcm.0b013e328365b554] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
33
|
Leftheriotis D, Flevari P, Theodorakis G, Rigopoulos A, Ikonomidis I, Panou F, Sourides V, Simitsis P, Giannakakis G, Aidonidis I, Rizos I, Anastasiou-Nana M. The Effects of Ranolazine on Paroxysmal Atrial Fibrillation in Patients with Coronary Artery Disease: A Preliminary Observational Study. J Atr Fibrillation 2014; 6:940. [PMID: 27957034 DOI: 10.4022/jafib.940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/03/2014] [Accepted: 02/10/2014] [Indexed: 12/19/2022]
Abstract
The impact of ranolazine, an anti-ishemic agent with antiarrhythmic properties, on paroxysmal atrial fibrillation (PAF) in patients with coronary artery disease (CAD) remains unclear. Pacing devices can be useful tools for disclosing even asymptomatic PAF. Purpose of this study is to assess the effect of ranolazine on atrial fibrillation (AF), in patients with CAD, PAF and a dual-chamber pacemaker. We studied 74 patients with CAD, PAF, and sick sinus syndrome or atrio-ventricular block, treated with pacemakers capable to detect PAF episodes. The total time in AF, AF burden, and the number of PAF episodes within the last 6 months before enrolment in the study, mean AF duration per episode, and the QTc interval were initially assessed. Subsequently, patients were randomized into additional treatment with ranolazine (375 mg twice daily) or placebo. Following six months of treatment, all parameters were reassessed and compared to those before treatment. Ranolazine was associated with shorter total AF duration (81.56±45.24 hours versus 68.71±34.84 hours, p=0.002), decreased AF burden (1.89±1.05% versus 1.59±0.81%, p=0.002), and shortened mean AF duration (1.15±0.41 hours versus 0.92±0.35 hours, p=0.01). In the placebo group no such differences were observed. In both groups, no significant differences in the number of PAF episodes and QTc duration were observed. We conclude that in patients with CAD and PAF, ranolazine reduces the total time in AF, AF burden, and mean AF duration. These findings may imply additional antiarrhythmic properties of ranolazine on atrial myocardium and might indicate the necessity of its use in ischemic patients with PAF.
Collapse
Affiliation(s)
| | - Panayota Flevari
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - George Theodorakis
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece (Hellas)
| | - Angelos Rigopoulos
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Ignatios Ikonomidis
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Fotis Panou
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Vassilios Sourides
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Panagiotis Simitsis
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Georgios Giannakakis
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Isaac Aidonidis
- Medical School of Larissa, Department of Physiology, Larissa, Greece (Hellas)
| | - Ioannis Rizos
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | | |
Collapse
|
34
|
Koskinas KC, Fragakis N, Katritsis D, Skeberis V, Vassilikos V. Ranolazine enhances the efficacy of amiodarone for conversion of recent-onset atrial fibrillation. Europace 2014; 16:973-9. [DOI: 10.1093/europace/eut407] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
35
|
Savelieva I, Graydon R, Camm AJ. Pharmacological cardioversion of atrial fibrillation with vernakalant: evidence in support of the ESC Guidelines. Europace 2013; 16:162-73. [DOI: 10.1093/europace/eut274] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Saklani P, Skanes A. Novel anti-arrhythmic medications in the treatment of atrial fibrillation. Curr Cardiol Rev 2013; 8:302-9. [PMID: 22920483 PMCID: PMC3492814 DOI: 10.2174/157340312803760785] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 04/24/2012] [Accepted: 04/24/2012] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is a prevalent condition particularly amongst the elderly, which contributes to both morbidity and mortality. The burden of disease has lead to significant increases in health care utilization and cost in recent years. Treatment of Atrial fibrillation consists of either a rate or rhythm control strategy. Rhythm control is achieved using medical management and/or catheter ablation. In spite of major strides in catheter ablation, this procedure remains a second line treatment of AF. Anti-arrhythmic medications represent the main treatment modality for the maintenance of sinus rhythm. Amiodarone has been used for decades because of its efficacy and lack of pro-arrhythmia despite numerous extra-cardiac side effects. Novel agents such as Dronedarone were designed to emulate Amiodarone without the extra-cardiac side effects. Unfortunately recent trials have raised concerns for the safety of this medication in certain patients. Other agents such as Vernakalant and Ranolazine are in development that promise to be more atrial selective in their action, thereby potentially avoiding pro-arrhythmia and heart failure side effects. It remains to be seen however if one or more of these agents achieves the required high efficacy and safety threshold. This review summarizes the main anti-arrhythmic clinical trials, early phase trials involving novel agents and examines the conflicting data relating to Dronedarone.
Collapse
Affiliation(s)
- Pradyot Saklani
- The University of Western Ontario, Arrhythmia Service, Division of Cardiology, London, Ontario, Canada
| | | |
Collapse
|
37
|
Verrier RL, Kumar K, Nieminen T, Belardinelli L. Mechanisms of ranolazine's dual protection against atrial and ventricular fibrillation. Europace 2013; 15:317-24. [PMID: 23220484 PMCID: PMC3578672 DOI: 10.1093/europace/eus380] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 10/22/2012] [Indexed: 12/19/2022] Open
Abstract
Coronary artery disease and heart failure carry concurrent risk for atrial fibrillation and life-threatening ventricular arrhythmias. We review evidence indicating that at therapeutic concentrations, ranolazine has potential for dual suppression of these arrhythmias. Mechanisms and clinical implications are discussed.
Collapse
Affiliation(s)
- Richard L Verrier
- Division of Cardiovascular Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-3908, USA.
| | | | | | | |
Collapse
|
38
|
Abstract
Ranolazine is currently approved for use in chronic angina. The basis for this use is likely related to inhibition of late sodium channels with resultant beneficial downstream effects. Randomized clinical trials have demonstrated an improvement in exercise capacity and reduction in angina episodes with ranolazine. This therapeutic benefit occurs without the hemodynamic effects seen with the conventional antianginal agents. The inhibition of late sodium channels as well as other ion currents has a central role in the potential use of ranolazine in ischemic heart disease, arrhythmias, and heart failure. Despite its QTc-prolonging action, albeit minimal, clinical data have not shown a predisposition to torsades de pointes, and the medication has shown a reasonable safety profile even in those with structural heart disease. In this article we present the experimental and clinical data that support its current therapeutic role, and provide insight into potential future clinical applications.
Collapse
Affiliation(s)
- Nael Hawwa
- Internal Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | |
Collapse
|
39
|
Abstract
The anti-arrhythmic efficacy of the late sodium channel current (late I(Na)) inhibition has been convincingly demonstrated in the ventricles, particularly under conditions of prolonged ventricular repolarization. The value of late I(Na) block in the setting of atrial fibrillation (AF) remains poorly investigated. All sodium channel blockers inhibit both peak and late I(Na) and are generally more potent in inhibiting late vs. early I(Na). Selective late I(Na) block does not prolong the effective refractory period (ERP), a feature common to practically all anti-AF agents. Although the late I(Na) blocker ranolazine has been shown to be effective in suppression of AF, it is noteworthy that at concentrations at which it blocks late I(Na) in the ventricles, it also potently blocks peak I(Na) in the atria, thus causing rate-dependent prolongation of ERP due to development of post-repolarization refractoriness. Late I(Na) inhibition in atria is thought to suppress intracellular calcium (Ca(i))-mediated triggered activity, secondary to a reduction in intracellular sodium (Na(i)). However, agents that block late I(Na) (ranolazine, amiodarone, vernakalant, etc) are also potent atrial-selective peak I(Na) blockers, so that the reduction of Na(i) loading in atrial cells by these agents can be in large part due to the block of peak I(Na). The impact of late I(Na) inhibition is reduced by the abbreviation of the action potential that occurs in AF patients secondary to electrical remodeling. It stands to reason that selective late I(Na) block may contribute more to inhibition of Ca(i)-mediated triggered activity responsible for initiation of AF in clinical pathologies associated with a prolonged atrial APD (such as long QT syndrome). Additional studies are clearly needed to test this hypothesis.
Collapse
|
40
|
|
41
|
Tzeis S, Andrikopoulos G. Antiarrhythmic properties of ranolazine – from bench to bedside. Expert Opin Investig Drugs 2012; 21:1733-41. [DOI: 10.1517/13543784.2012.716826] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|