Comparison of Effectiveness and Safety of Ranolazine Versus Amiodarone for Preventing Atrial Fibrillation After Coronary Artery Bypass Grafting

• Published in: The American journal of cardiology Vol. 108; no. 5; pp. 673 - 676
• Main Authors: Miles, Ronald H., Passman, Rod, Murdock, David K.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2011; Elsevier; Elsevier Limited
• Subjects: Acetanilides - administration & dosage; Acetanilides - therapeutic use; Aged; Amiodarone - administration & dosage; Amiodarone - therapeutic use; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Chi-Square Distribution; Coronary Artery Bypass - adverse effects; Coronary heart disease; Enzyme Inhibitors - administration & dosage; Enzyme Inhibitors - therapeutic use; Female; Heart; Heart surgery; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Pharmacology; Piperazines - administration & dosage; Piperazines - therapeutic use; Prescription drugs; Ranolazine; Retrospective Studies; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Vasodilator Agents - administration & dosage; Vasodilator Agents - therapeutic use; Arrhythmia; Atrial fibrillation; Cardiovascular disease; Amiodarone; Coronary heart disease; Excitability disorder; Ranolazine; Prevention; Coronary artery bypass; Complication; Circulatory system; Safety; Cardiology; Comparative study
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2011.04.017

Atrial fibrillation (AF) is common after coronary artery bypass grafting (CABG) and increases the morbidity and cost. Amiodarone reduces AF after CABG. Ranolazine, an antianginal agent, also prolongs atrial refractoriness and inhibits after depolarizations and triggered activity; effects that could decrease AF after CABG. The present study compared amiodarone versus ranolazine for the prevention of AF after CABG. A retrospective cohort study of patients undergoing CABG at Aspirus Hospital from June 2008 to April 2010. The patients received either amiodarone (400 mg preoperatively followed by 200 mg twice daily for 10 to 14 days) or ranolazine (1,500 mg preoperatively followed by 1,000 mg twice daily for 10 to 14 days). The primary end point was any identified AF after CABG. A total of 393 consecutive patients undergoing CABG (mean age 65 ± 10 years, 72% men) received either amiodarone (n = 211 [53.7%]) or ranolazine (n = 182 [46.3%]). AF occurred in 26.5% of the amiodarone-treated patients compared to 17.5% of the ranolazine-treated patient (p = 0.035). The univariate predictors of AF included amiodarone use, age, chronic lung disease, and congestive heart failure. The multivariate predictors of AF included amiodarone use (odds ratio 1.7, 95% confidence interval 1.01 to 2.91, p = 0.045 vs ranolazine), age (odds ratio 2.2 per 10 years, 95% confidence interval 1.63 to 2.95, p <0.001), and chronic lung disease (odds ratio 1.86, 95% confidence interval 1.00 to 3.43, p = 0.049). No difference was found in the risk of adverse events between the 2 therapies. In conclusion, ranolazine was independently associated with a significant reduction of AF compared to amiodarone after CABG, with no difference in the incidence of adverse events. Randomized studies should be conducted to confirm these results.