Ranolazine in Atrial Fibrillation Following An ELectricaL CardiOversion

Study Overview
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Brief Summary
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Dose-ranging Phase II study testing the efficacy and safety of 3 doses of Ranolazine (low, intermediate and high, given BID) versus placebo in maintaining sinus rhythm after successful electrical cardioversion in patients with persistent atrial fibrillation (AFib). After successful cardioversion and subsequent randomisation, patients report trans-telephonic EGCs on a daily basis to a central core ECG facility. Maximum treatment duration is 112 days (16 weeks).

Detailed Description
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Patients with persistent AFib are screened for eligibility and undergo direct current cardioversion (DCC). If DCC is successful (defined as persistence of sinus rhythm 2 h post-DCC) patients meeting all the inclusion criteria and none of the exclusion criteria are randomly assigned to the treatment arms (Ranolazine low, intermediate, high dose or placebo, given BID). Transtelephonic ECG devices (TT-ECG) are used for recording of AFib recurrence to be read by a Central ECG Core Laboratory. Any symptoms indicative of AFib have to be recorded by the patient in a diary. Study Visits are held for screening (Visit 1), at DCC and randomisation (Visit 2), one week post DCC (Visit 3), after 8 weeks of treatment (Visit 4), and at end of treatment (Visit 5). A safety follow-up telephone call is held 2 weeks after end of treatment. 12-Lead ECGs are performed at every visit. Safety evaluations include regular safety laboratory blood and urine tests, 12-lead ECGs and the continuous recording of adverse events. A double-dummy technique is used to ensure double-blind conditions.

Official Title
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A Randomised, Double-blind, Double-dummy, Placebo-controlled, Dose-ranging Phase II Study Assessing Ranolazine in the Maintenance of Sinus Rhythm After Electrical Cardioversion in Patients With Non-permanent Atrial Fibrillation.

Conditions
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Persistent Atrial Fibrillation

Intervention / Treatment
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* Drug: Ranolazine
* Drug: Ranolazine
* Drug: Ranolazine
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female patients 18 years and older Patients with persistent AF suitable for electrical direct current cardioversion (DCC) A female of childbearing potential may be enrolled providing she has a negative pregnancy test at baseline and is routinely using an effective method of birth control resulting in a low failure rate until end of study Able to give written informed consent before any study related procedure Able to attend all the visits scheduled in the study Exclusion Criteria: Patients with first diagnosed AF or patients with paroxysmal AF Patients with long-standing persistent AF or permanent AF Patients having known concurrent temporary secondary causes of AF such as alcohol intoxication, pulmonary embolism, hyperthyroidism, pneumonia, hypoxemia, acute pericarditis or myocarditis Patients having undergone atrial catheter ablation for AF Patients carrying a pacemaker Patients with electrolytes imbalances that may cause cardiac arrhythmias, e.g. potassium < 3.5 mmol/L or > 5.5 mmol/L Patients with any contra-indications to Ranexa according to the drug-specific product characteristics Patients taking class I or Class III antiarrhythmic agents within 3 days of planned randomisation Patients taking beta-blockers unless used on stable doses for at least 2 weeks prior to the planned randomisation. Single doses of Intravenous beta-blockers are allowed up to 10 hours from the planned randomisation Patients taking Dronedarone or oral Amiodarone within 2 weeks and 3 months of planned randomisation, respectively Patients with a history of ECG abnormalities that in the opinion of the Investigator render the subject unsuitable for the trial, including history of congenital or a family history of long QT syndrome and a QTc interval ≥500 msec at Screening Patients with congestive heart failure NYHA grade III and IV; Patients with any serious intercurrent illness (including psychiatric and neurological disorders) which, in the opinion of the Investigator, is incompatible with the protocol. Patients taking Metformin at a total daily dose greater than 1000 mg. Patients taking Simvastatin at a total daily dose greater than 20 mg.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ranolazine low dose<br>Ranolazine, low dose, oral, BID | Drug: Ranolazine<br>* Oral administration, BID; for a maximum of 112 days.<br>* Other names: Ranexa (R);|
| Experimental: Ranolazine intermediate dose<br>Ranolazine, intermediate dose, oral, BID | Drug: Ranolazine<br>* Oral administration, BID; for a maximum of 112 days.<br>* Other names: Ranexa (R);|
| Experimental: Ranolazin high dose<br>Ranolazine, high dose, oral, BID | Drug: Ranolazine<br>* Oral administration, BID; for a maximum of 112 days.<br>* Other names: Ranexa (R);|
| Placebo Comparator: Placebo<br>Placebo (sugar pill), oral, BID. | Drug: Placebo<br>* Oral administration, BID; for a maximum of 112 days.<br>* Other names: Sugar pill;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time From Randomization to First Documented AF Recurrence. | Time to first AF recurrence reported by patient-reported TT-ECG or 12-Lead ECG at the study site, whichever occurred first. Patients discontinuing the study without AF were censored at the time of the last available ECG. | 16 weeks (112 days) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients With Documented AF Recurrences |  | 16 weeks (112 days) | 
| Time From Randomization to First Documented and Confirmed AF Recurrence | A confirmed AF recurrence was defined as a documented AF recurrence which was confirmed by a consecutive ECG performed at least 1 hour after first AF documentation. | 16 weeks (112 days) | 
| Number of Patients With Documented and Confirmed AF Recurrences |  | 16 weeks (112 days) | 
| Time From Randomization to First Documented AF Recurrence in Patients With Sinus Rhythm 48 Hours After Cardioversion | Excluding patients with early relapses (within 48 hours) while the study drug, started after cardioversion, had not yet reached steady-state. | 16 weeks (112 days) | 
| Number of Patients in Sinus Rhythm 48 Hours After Cardioversion With Documented AF Recurrence | Documented AF recurrences in those patients who did not experience early relapses (within 48 hours after cardioversion) | 16 weeks (112 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Atrial Fibrillation, Ranolazine, Arrhythmias, Cardiac, Antiarrhythmic Agents, Cardiac Electroversion, Ranexa