Angina Drug May Reduce Death Risk in Heart Failure Patients
Ranolazine reduces the risk for death and arrhythmia in patients with advanced heart failure and implantable cardioverter-defibrillators (ICDs), according to results of a new study.1
The study was presented at the Heart Rhythm Society Scientific Sessions 2018 on May 9, 2018.
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“There are limited treatment options for patients at high risk of ventricular arrhythmic events,” the researchers write. “Ranolazine is a drug with anti-ischemic and antiarrhythmic properties that uniquely blocks late sodium current, decreases intracellular calcium overload, and improves diastolic relaxation of the ventricles. The anti-ischemic and antiarrhythmic properties of Ranolazine might decrease the likelihood of arrhythmic events and improve the clinical course of patients with ventricular arrhythmias.”2
To determine whether features of more advanced heart failure influence antiarrhythmic response to ranolazine, the researchers conducted the Ranolazine in High-Risk ICD Patients (RAID) trial, in which 1012 patients with high-risk ICD with ischemic or nonischemic cardiomyopathy were randomly assigned to either ranolazine, 1000 mg, twice daily or placebo for 2 years.
The primary outcomes were ventricular tachycardia (VT) or ventricular fibrillation (VF) requiring antitachycardia pacing (ATP) therapy, ICD shocks, or death.
Advanced heart failure was defined as New York Heart Association (NYHA) Functional Classification III or IV or a B-type natriuretic peptide (BNP) level of 676 pg/ml or more.
Overall, 500 of 836 participants with available data (60%) had advanced heart failure, and 444 of 886 participants with available data (50%) had elevated BNP levels.
Primary analysis showed a nonsignificant reduction in death or VT/VF requiring appropriate ICD therapy.
Secondary analyses showed a significant reduction in the risk for first and recurrent VT of more than 220 bmp, which were treated with ATP.
“Ranolazine reduces the risk of VT<220 bpm in patients with signs and symptoms of advanced heart failure defined as NYHA class III/IV or elevated BNP ≥676 pg/ml,” the researchers conclude. “Ranolazine could be considered as an alternative to amiodarone, having a safer profile and not increasing mortality in advanced heart failure patients.”1
— Amanda Balbi
Reference:
- Zareba W, Daubert JP, McNitt S, et al; RAID Trial Investigators. Ranolazine decreases the risk of VT<220 bpm in advanced heart failure patients. Paper presented at: Heart Rhythm Society Scientific Sessions 2018; May 9-12, 2018; Boston, MA. http://brandresourcesgroupmedia.com/hrs/wp-content/uploads/2018/04/Ranolazine-Decreases-The-Risk-of-VT_220-bpm-In-Advanced-Heart-Failure-Patients.pdf.
- Ranolazine ICD Trial (RAID). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/heart_vascular_institute/clinical_trials/atrial-fibrillation/raid.html. Accessed May 10, 2018.
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