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Case Reports
. 2025 Jun 18;30(15):103755.
doi: 10.1016/j.jaccas.2025.103755.

Ranolazine in Persistent Atrial Fibrillation: Evidence From a Case Series of Cardioversions

Sagarika Raman  1 , Philip Rutherford  2 , Calum Presslie  2 , Honey Thomas  3 , Alykhan Bandali  4 , Moloy Das  5
Affiliations
Case Reports

Ranolazine in Persistent Atrial Fibrillation: Evidence From a Case Series of Cardioversions

Sagarika Raman et al. JACC Case Rep. .

Abstract

Background: Direct-current cardioversion (DCCV) is used as a rhythm-control strategy in persistent symptomatic atrial fibrillation (AF) and is often supported by antiarrhythmic drugs (AADs), usually class III AADs, to improve outcomes. Although primarily used as an antianginal agent, ranolazine has also shown evidence of antiarrhythmic properties in AF.

Cases: We detail cases where ranolazine was used as an AAD for persistent AF: 6 patients who chemically cardioverted on ranolazine monotherapy and 4 patients on combination therapy with ranolazine and a class III AAD (2 chemical cardioversions and 2 successful DCCVs) who had previously failed DCCV on a class III AAD.

Discussion: These cases demonstrate ranolazine's beneficial antiarrhythmic effects, both as a single agent and in combination with a class III AAD. This raises the possibility that ranolazine could play a greater role in persistent AF management and merits further investigation in randomized controlled trials.

Keywords: atrial fibrillation; atrial tachycardia; cardioversion; electrophysiology.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Patients Who Achieved Cardioversion From AF to SR on Ranolazine Monotherapy (n = 6) and on Combination AAD + Ranolazine (n = 4) AAD = antiarrhythmic drug; DCCV = direct-current cardioversion.
See this image and copyright information in PMC

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