From the Guidelines
Trimetazidine can be considered for patients with left anterior fascicular block (LAFB) who also have symptoms of angina, as it may help improve exercise tolerance and reduce angina frequency, but it is not specifically indicated for the treatment of LAFB itself. According to the 2024 ESC guidelines for the management of chronic coronary syndromes 1, trimetazidine may be considered as add-on therapy in patients with inadequate control of symptoms while on treatment with beta-blockers and/or calcium channel blockers (CCBs), or as part of initial treatment in properly selected patients. The guidelines recommend long-acting nitrates or ranolazine as first-line add-on therapy, but trimetazidine is an option for patients who cannot tolerate or have contraindications to these medications.
- Key points to consider when prescribing trimetazidine for patients with LAFB and angina include:
- The patient's symptoms and medical history, including any underlying conditions that may be contributing to the LAFB
- The potential benefits and risks of trimetazidine, including its effects on myocardial metabolism and potential interactions with other medications
- The need for regular cardiac evaluation and monitoring to determine the effectiveness of treatment and identify any potential complications.
- It is essential to note that LAFB is a conduction abnormality that typically does not require specific medication treatment unless it is associated with symptoms or other cardiac conditions, and trimetazidine is primarily used to treat stable angina pectoris by improving myocardial metabolism without affecting hemodynamic parameters, as stated in the guidelines 1.
From the Research
Trimetazidine and Left Anterior Fascicles Block
- There is no direct evidence in the provided studies that specifically addresses the use of trimetazidine in patients with left anterior fascicles block.
- However, study 2 mentions left anterior fascicular block as one of the conduction abnormalities seen after transcatheter aortic valve replacement, but it does not discuss the use of trimetazidine in this context.
- Studies 3, 4, and 5 discuss the use of trimetazidine in various cardiovascular conditions, including coronary artery disease, heart failure, and peripheral artery disease, but do not specifically address its use in patients with left anterior fascicles block.
- Study 6 shows that trimetazidine improves left ventricular function and quality of life in elderly patients with coronary artery disease, but it does not provide information on its use in patients with left anterior fascicles block.
Potential Benefits and Risks of Trimetazidine
- Trimetazidine has been shown to improve left ventricular function and reduce angina symptoms in patients with coronary artery disease 3, 6.
- However, study 5 found that trimetazidine did not significantly reduce the incidence of cardiac events or improve outcomes in patients who had undergone percutaneous coronary intervention.
- The safety profile of trimetazidine is generally considered to be good, with no significant increase in adverse events compared to placebo 5.