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Ventricular fibrillation (VF) is characterized by rapid (>300 beats a per minute), irregular electrical activation with variable electrocardiographic waveforms that prevents coordinated myocardial contraction, resulting in immediate loss of cardiac output.1 It most commonly occurs in the context of coronary artery disease.2,3 Resuscitation efforts are critically time-dependent: with each minute of untreated VF, the survival rate declines […]

Ranolazine improves autonomic balance in heart failure when added to guideline-driven therapy

Gary L. Murray, Joseph Colombo
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Published Online: Aug 16th 2018 Heart International. 2014;9(2):59-65 DOI: https://doi.org/10.5301/heartint.5000215
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Abstract

Overview

Background. The effect of ranolazine (RAN) on cardiac autonomic balance in congestive heart failure (CHF) was
studied.
Methods. Fifty-four CHF patients were randomized to (1) open-label RAN (RANCHF) added to usual therapy vs.
(2) usual therapy (NORANCHF). Parasympathetic and sympathetic (P&S) measurements were taken at baseline
and at 12 months.
Results. A total of 16/27 (59%) patients in both groups had initially abnormal P&S measures, including high
sympathovagal balance (SB), cardiovascular autonomic neuropathy (CAN) or both. High SB normalized in 10/12
(83%) RANCHF patients vs. 2/11 (18%) NORANCHF patients. SB became high in 5/11 (45%) NORANCHF vs. 1/11
(9%) RANCHF patients. CAN improved in 4/6 (67%) RANCHF patients vs. 5/7 (45%) NORANCHF patients. CAN
developed in 1/11 (9%) RANCHF vs. 4/11 (36%) NORANCHF patients. Since improved P&S in RANCHF patients
seemed independent of improved brain natriuretic peptide and impedance cardiography (BioZ) measurements,
5 day RAN was given to 30 subjects without CHF but with high SB or CAN. P&S improved in 90% of these subjects.
Conclusions. RAN improves unfavorable P&S activity in CHF possibly by a direct effect upon autonomic sodium
channels.

Keywords

Cardiovascular autonomic neuropathy, Congestive heart failure, Major adverse cardiac events, Parasympathetic function, Patient outcomes, Ranolazine, Sympathetic function

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Article Information

Disclosure

Financial support: No grants or funding have been received for this
study.

Correspondence

Gary L. Murray Director, The Heart and Vascular Institute 7205 Wolf River Blvd Germantown TN, 38138, USA drglmurray@hotmail.com

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