Ranolazine: ic Effect, Efficacy, and Safety in Patients with Cardiac Arrhythmias

� Ranolazine is currently approved as an antianginal agent in patients with chronic angina (class IIA). � Ranolazine exhibits antiarrhythmic effects that are related to its multichannel blocking effect, pre- dominantly inhibition of late sodium (late INa) current and the rapid potassium rectifier current (IKr), as well as ICa, late ICa, and INa-Ca. It also suppresses the early and delayed afterdepolarizations. � Ranolazine is effective in the suppression of atrial and ventricular arrhythmias (off-label use) without significant proarrhythmic effect. � Currently, ongoing trials are evaluating the efficacy and safety of ranolazine in patients with cardiac arrhythmias; preliminary results suggest that ranolazine, when used alone or in combination with dronedarone, is safe and effective in reducing atrial fibrillation. � Ranolazine is not currently approved by the US Food and Drug Administration as an antiarrhythmic agent.