Ranolazine Unveiled: Rediscovering an Old Solution in a New Light

Abstract

Ranolazine is an anti-anginal medication that has demonstrated antiarrhythmic properties by inhibiting both late sodium and potassium currents. Studies have shown promising results for ranolazine in treating both atrial fibrillation and ventricular arrhythmias, particularly when used in combination with other medications. This review explores ranolazine's mechanisms of action and its potential role in cardiac arrhythmias treatment in light of previous clinical studies.

Keywords: arrhythmias; atrial fibrillation; ranolazine; sodium current inhibition; ventricular arrhythmias.

Figure 1

Summary of ranolazine tissue-specific effects on APD. Ranolazine’s effects on action potential are tissue-specific (green curves), depending on the interaction with rapid INa, late INa, IKr current, and their different representation on cardiac cells. APD: action potential duration; INa: inward sodium current; IKr: inward rectifier potassium current; M cells: midmyocardial cells; orange curve: standard action potential; green curve: ranolazine effect on action potential.

Figure 2

Ranolazine antiarrhythmic effect according to arrhythmic setting (atrial fibrillation and ventricular arrhythmias). AF: atrial fibrillation; APD: action potential duration; EAD: early after depolarization; CV: cardioversion; LQTs: Long QT Syndrome; VA: ventricular arrhythmia; HCM: hypertrophic cardiomyopathy; TDR: transmural dispersion of repolarization; blue curve: action potential without ranolazine; green curve: action potential under ranolazine. Red arrow: TDR without ranolazine; Green arrow: TDR with ranolazine.