Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart .
Although atrial fibrillation ( AF ) is the most common sustained arrhythmia seen during daily cardiovascular physician practice , its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term .
Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation .
Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited .
Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial.
CONTEXT Ranolazine is a novel antianginal agent that reduces ischemia in patients with chronic angina but has not been studied in patients with acute coronary syndromes ( ACS ) . OBJECTIVE To determine the efficacy and safety of ranolazine during long-term treatment of patients with non-ST-elevation ACS . DESIGN , SETTING , AND PATIENTS A r and omized , double-blind , placebo-controlled , multinational clinical trial of 6560 patients within 48 hours of ischemic symptoms who were treated with ranolazine ( initiated intravenously and followed by oral ranolazine extended-release 1000 mg twice daily , n = 3279 ) or matching placebo ( n = 3281 ) , and followed up for a median of 348 days in the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes (MERLIN)-TIMI 36 trial between October 8 , 2004 , and February 14 , 2007 . MAIN OUTCOME MEASURES The primary efficacy end point was a composite of cardiovascular death , myocardial infa rct ion ( MI ) , or recurrent ischemia through the end of study . The major safety end points were death from any cause and symptomatic documented arrhythmia . RESULTS The primary end point occurred in 696 patients ( 21.8 % ) in the ranolazine group and 753 patients ( 23.5 % ) in the placebo group ( hazard ratio [ HR ] , 0.92 ; 95 % confidence interval [ CI ] , 0.83 - 1.02 ; P = .11 ) . The major secondary end point ( cardiovascular death , MI , or severe recurrent ischemia ) occurred in 602 patients ( 18.7 % ) in the ranolazine group and 625 ( 19.2 % ) in the placebo group ( HR , 0.96 ; 95 % CI , 0.86 - 1.08 ; P = .50 ) . Cardiovascular death or MI occurred in 338 patients ( 10.4 % ) allocated to ranolazine and 343 patients ( 10.5 % ) allocated to placebo ( HR , 0.99 ; 95 % CI , 0.85 - 1.15 ; P = .87 ) . Recurrent ischemia was reduced in the ranolazine group ( 430 [ 13.9 % ] ) compared with the placebo group ( 494 [ 16.1 % ] ; HR , 0.87 ; 95 % CI , 0.76 - 0.99 ; P = .03 ) . QTc prolongation requiring a reduction in the dose of intravenous drug occurred in 31 patients ( 0.9 % ) receiving ranolazine compared with 10 patients ( 0.3 % ) receiving placebo .  Symptomatic documented arrhythmias did not differ between the ranolazine ( 99 [ 3.0 % ] ) and placebo ( 102 [ 3.1 % ] ) groups ( P = .84 ) . No difference in total mortality was observed with ranolazine compared with placebo ( 172 vs 175 ; HR , 0.99 ; 95 % CI , 0.80 - 1.22 ; P = .91 ) . CONCLUSIONS The addition of ranolazine to st and ard treatment for ACS was not effective in reducing major cardiovascular events .  Ranolazine did not adversely affect the risk of all-cause death or symptomatic documented arrhythmia . Our findings provide support for the safety and efficacy of ranolazine as antianginal therapy . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00099788
Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart .
Although atrial fibrillation ( AF ) is the most common sustained arrhythmia seen during daily cardiovascular physician practice , its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term .
Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation .
Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited .