Ranolazine for rhythm control in atrial fibrillation: A systematic review and meta-analysis

Background/objectives: Available pharmacological options for rhythmcontrol strategy in atrial fibrillation (AF) are limited by sub-optimal efficacy and potentially serious adverse events. The aimof the presentmeta-analysis is to determine the efficacy and safety of ranolazine for AF management. Methods: The present meta-analysiswas conducted according to current recommendations (CRD42016039000). Two large medical databases (MEDLINE and Scopus) were systematically searched and fromthat eight randomized clinical trials and two non-randomized observational studies were identified. The primary endpoint was to determine the efficacy of ranolazine to prevent AF episodes. Secondary efficacy endpoints were: efficacy in converting AF to sinus rhythm, time to conversion, and reduction in AF burden. Safety endpoints included death, serious adverse events, and QTc prolongation. Results: Ranolazine was found to be effective in reducing the risk of AF when compared to control (OR 0.47; 95% CI 0.29-0.76; p =0.003). Subgroup analysis showed a larger effect size in post-operative AF (OR 0.29; 95% CI 0.11-0.77; p=0.03) when compared to no post-operative AF (OR 0.70; 95% CI 0.54-0.83; p=0.005). Ranolazine increased the chances of successful cardioversion when added to amiodarone over amiodarone alone (OR 3.11; 95% CI 1.42-6.79; p =0.004) while significantly reducing time to conversion (SMD-2.83 h; 95% CI-4.69 - -0.97 h; p < 0.001). Overall risks of death, adverse events, and QTc prolongationwere comparable between ranolazine and control group. Conclusions: Ranolazine is an effective option when used for rhythm control strategy in AF. The use of ranolazine seems to be safe and associated with few adverse events. (C) 2016 Elsevier Ireland Ltd. All rights reserved.