Ranolazine for Atrial Fibrillation: Too Good to be True?

Citation : Joseph J. Gard, Samuel J. Asirvatham. Ranolazine for Atrial Fibrillation: Too Good to be True? .JAFIB.2010 May;Volume 2 Issue(1): 711-714.

Several management options for patients with symptomatic atrial fibrillation (AF) available today were not even in the realm of discussion two decades ago. These advances, however, have primarily involved invasive management options for patients with drug refractory arrhythmia. After the recognition that electrical isolation of the thoracic veins benefits patients with paroxysmal AF, a slew of more involved ablative techniques evolved. Major breakthroughs in antiarrhythmic therapy, however, have not paralleled this meteoric development of invasive techniques. The drive for invasive procedures has, in fact, been widely based on the lack of availability of simple, effective, and safe pharmacological options for AF. The introduction of dronedarone into clinical practice represented a recent addition to antiarrhythmic therapy options for use in the management of patients with AF. This agent is an analogue of amiodarone but devoid of the iodine moiety which allows its use without the well-recognized and dreaded organ toxicity associated with long-term use. Nevertheless, a significant need exists for a drug with limited side effects that can be used for symptomatic intermittent AF without the need for daily chronic use, fear of organ toxicity, and concern regarding proarrhythmia in patients with structural heart disease.