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Amiodarone plus Ranolazine for Conversion of Post-Cardiac Surgery Atrial Fibrillation: Enhanced Effectiveness in Reduced Versus Preserved Ejection Fraction Patients

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Abstract

Purpose

Ranolazine (RAN) added to amiodarone (AMIO) has been shown to accelerate termination of postoperative atrial fibrillation (POAF) following coronary artery bypass surgery in patients without heart failure (HF). This study aimed to investigate if treatment efficacy with AMIO or AMIO + RAN differs between patients with concomitant HF with reduced or preserved ejection fraction (HFrEF or HFpEF).

Methods

Patients with POAF and HFrEF (n = 511, 446 males; 65 ± 9 years) and with HFpEF (n = 301, 257 males; 66 ± 10 years) were enrolled. Onset of AF occurred 2.15 ± 1.0 days after cardiac surgery, and patients within each group were randomly assigned to receive either AMIO monotherapy (300 mg in 30 min + 1125 mg in 36 h iv) or AMIO+RAN combination (500 mg po + 375 mg, after 6 h and 375 mg twice daily thereafter). Primary endpoint was the time to conversion of POAF within 36 h after initiation of treatment.

Results

AMIO restored sinus rhythm earlier in HFrEF vs. in HFpEF patients (24.3 ± 4.6 vs. 26.8 ± 2.8 h, p < 0.0001). AMIO + RAN converted POAF faster than AMIO alone in both HFrEF and HFpEF groups, with conversion times 10.4 ± 4.5 h in HFrEF and 12.2 ± 1.1 h in HFpEF patients (p < 0.0001). Left atrial diameter was significantly greater in HFrEF vs. HFpEF patients (48.2 ± 2.6 vs. 35.2 ± 2.9 mm, p < 0.0001). No serious adverse drug effects were observed during AF or after restoration to sinus rhythm in any of the patients enrolled.

Conclusion

AMIO alone or in combination with RAN converted POAF faster in patients with reduced EF than in those with preserved EF. Thus, AMIO + RAN seems to be a valuable alternative treatment for terminating POAF in HFrEF patients.

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Acknowledgments

We thank Gionga Persefoni and Raptis Dimitrios for your collaboration in collecting patient data. The authors also thank Dr. Stella S Daskalopoulou (McGill University Health Centre, Montreal. Quebec, Canada) for her considerable help by the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Thoracic & Cardiovascular Surgery, University Hospital of Larissa, Larissa, Greece

    Vasilios Simopoulos, Athanasios Hevas & Nikolaos Tsilimingas

  2. Department of Physiology, School of Medicine, University of Thessaly, Larissa Medical School, 41500, Larissa, Greece

    Apostolia Hatziefthimiou & Isaac Aidonidis

  3. Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Konstantina Dipla

  4. Department of Cardiology, University General Hospital of Larissa, Larissa, Greece

    Ioannis Skoularigis

Authors
  1. Vasilios Simopoulos
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  2. Athanasios Hevas
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  3. Apostolia Hatziefthimiou
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  4. Konstantina Dipla
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  5. Ioannis Skoularigis
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  6. Nikolaos Tsilimingas
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  7. Isaac Aidonidis
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Correspondence to Isaac Aidonidis.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Simopoulos, V., Hevas, A., Hatziefthimiou, A. et al. Amiodarone plus Ranolazine for Conversion of Post-Cardiac Surgery Atrial Fibrillation: Enhanced Effectiveness in Reduced Versus Preserved Ejection Fraction Patients. Cardiovasc Drugs Ther 32, 559–565 (2018). https://doi.org/10.1007/s10557-018-6832-8

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  • DOI: https://doi.org/10.1007/s10557-018-6832-8

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