From the Guidelines
Ranolazine is not recommended for treating premature ventricular contractions (PVCs) as it is not mentioned in the current guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1. The current guidelines suggest that electrical cardioversion or defibrillation is the intervention of choice to acutely terminate ventricular arrhythmias (VAs) in acute coronary syndromes (ACS) patients, and early administration of beta-blockers can help prevent recurrent arrhythmias 1. In patients with recurrent VT or VF triggered by premature ventricular complex (PVC) arising from partially injured Purkinje fibres, catheter ablation is very effective and should be considered 1. Some key points to consider when managing PVCs include:
- Electrical cardioversion or defibrillation as the first line of treatment
- Early administration of beta-blockers to prevent recurrent arrhythmias
- Consideration of catheter ablation for recurrent VT or VF triggered by PVC
- The use of anti-arrhythmic drugs such as amiodarone or lidocaine in specific cases, but not ranolazine 1. It's essential to consult with a cardiologist to determine the best course of treatment for PVCs, as the management strategy may vary depending on the individual case and underlying conditions.
From the Research
Role of Ranolazine in Treating Premature Ventricular Contractions (PVCs)
- Ranolazine has been shown to be effective in reducing PVCs in patients with symptomatic premature ventricular contractions due to triggered ectopy 2.
- The reduction in PVC burden was greatest among individuals with reduced ventricular function, perhaps due to enhanced late sodium current associated with cardiomyopathy 3.
- Ranolazine has been found to reduce PVCs by 71% (mean: 13,329 to 3,837; p < 0.001), ventricular bigeminy by 80% (4,168 to 851; p < 0.001), ventricular couplets by 78% (374 to 81; p < 0.001), and ventricular tachycardia by 91% (56 to 5; p < 0.001) 2.
- Ranolazine appears to be effective for symptomatic ventricular arrhythmias, including PVCs, and may be a useful treatment option for patients with PVC-induced cardiomyopathy 3, 4.
- A systematic review of the existing data found that ranolazine has a beneficial impact on ventricular arrhythmias, including ventricular tachycardia/fibrillation, premature ventricular beats, and ICD interventions in different clinical settings 5.
Mechanism of Action
- Ranolazine preferentially blocks the late sodium current, which is enhanced among patients with cardiomyopathy, making it a promising target population for ranolazine 3.
- The antiarrhythmic properties of ranolazine are thought to be due to its ability to suppress early and delayed afterdepolarizations (EAD/DAD), which can cause triggered ventricular ectopy 2.
Clinical Implications
- Ranolazine may be a useful treatment option for patients with symptomatic PVCs, particularly those with reduced ventricular function or PVC-induced cardiomyopathy 2, 3, 4.
- Further studies are needed to confirm the efficacy and safety of ranolazine for the treatment of PVCs and to determine its role in the management of PVC-induced cardiomyopathy 2, 3, 6.