P802Ranolazine - a new therapeutic option for patients with ventricular cardiac arrhythmias?

Abstract

Background: Pharmacological treatment of ventricular arrhythmias has significant limitations. Therefore, there is a strong need to implement new antiarrhythmic drugs into therapy. A potential option can be ranolazine - a drug with proven antianginal and potential anti-arrhythmic activity, which have thus far been recorded among patients with atrial fibrillation. Purpose: Analysis of the safety and effectiveness of ranolazine in the tratment of ventricular cardiac arrhythmias. Methods: The prospective evaluation included a group of 15 patients (M / F 13/2; avg. age 63±10 years) with recurrent significant ventricular arrhythmias (sustained ventricular tachycardia and/or non-sustained ventricular tachycardia, multiple ventricular premature complexes; an electrical storm (ES) was diagnosed in five patients) and for whom the standard treatment options including coronary revascularization and percutaneous ablation of ventricular arrhythmias had been exhausted: 11 patients with coronary artery disease (NYHA III/IV 9/2, avg. left ventricular ejection fraction [LVEF] 21% ± 5,7; ICD: 5, CRT-D: 6) and four with dilated cardiomyopathy (NYHA III/IV: 3/1 avg. LVEF: 26.5% ± 8.9; ICD: 3,CRTD: 1). The patients received ranolazine 375 mg twice daily for three months in addition to their standard pharmacotherapy including amiodarone and/or betablocker,. The severity of the arrhythmia was then assessed through a 24-hour ECG Holter monitoring and with an ICD/CRT-D memory recording. Results: In ten (67%) patients, we observed a significant reduction in ventricular arrhythmias - in two (13%) of them who had initially been hospitalized because of an ES, there was no intervention with a device and/or any recurrence of sustained ventricular tachycardia; in eight patients (53%), we observed a significant reduction in the number of premature ventricular beats (average of 59%) compared to the initial number. For three (20%) patients, the therapy was ineffective - two were hospitalized during the three-month follow-up because of an ES and there was no noticeable reduction in the number of ventricular arrhythmias in one patient. We observed no significant QT prolongation in any of the patients. Adverse reactions in the form of gastrointestinal symptoms (diarrhea: 1, constipation: 2) occurred in three patients (20%) and were the reason that the drug was withdrawn for two of them. Conclusion: Ranolazine seems to be safe and can be effective as a secondline therapy for ventricular cardiac arrhythmias in patients who have a high-risk of sudden cardiac death who have been protected with an ICD/CRT-D.