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• W2020163272 abstract "HomeCirculationVol. 123, No. 14Response to Letters Regarding Article, “Relationship Between Nonsustained Ventricular Tachycardia After Non-ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death: Observations From the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) Randomized Controlled Trial” Free AccessReplyPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReplyPDF/EPUBResponse to Letters Regarding Article, “Relationship Between Nonsustained Ventricular Tachycardia After Non-ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death: Observations From the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) Randomized Controlled Trial” Benjamin M. Scirica, MD, MPH, Eugene Braunwald, MD, Chester M. Hedgepeth, MD, PhD, Jie Qin, MS, David A. Morrow, MD, MPH, Luiz Belardinelli, MD, Whedy Wang, PhD, MPH, Ewa Karwatowska-Prokopczuk, MD, Jindrich Spinar, MD and Freek W.A. Verheugt, MD Benjamin M. SciricaBenjamin M. Scirica Search for more papers by this author , Eugene BraunwaldEugene Braunwald Search for more papers by this author , Chester M. HedgepethChester M. Hedgepeth Search for more papers by this author , Jie QinJie Qin Search for more papers by this author , David A. MorrowDavid A. Morrow Search for more papers by this author , Luiz BelardinelliLuiz Belardinelli Search for more papers by this author , Whedy WangWhedy Wang Search for more papers by this author , Ewa Karwatowska-ProkopczukEwa Karwatowska-Prokopczuk Search for more papers by this author , Jindrich SpinarJindrich Spinar Search for more papers by this author and Freek W.A. VerheugtFreek W.A. Verheugt Search for more papers by this author Originally published12 Apr 2011https://doi.org/10.1161/CIRCULATIONAHA.110.003525Circulation. 2011;123:e405We thank Dr Madias for his insightful comments regarding the limitations of current clinical risk stratification for sudden cardiac death after an acute coronary syndrome and the great clinical need for the development of more sophisticated tools. With over 40 000 days of continuous electrocardiogram monitoring, the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis in Myocardial Infarction 36 Trial (MERLIN-TIMI 36) is a rich database for future research, and we are currently investigating whether specific morphological features may identify a subset of more lethal ventricular arrhythmias. We appreciate Dr Madias's suggestions for additional analyses and have embarked on an evaluation of novel electrocardiogram techniques, such as heart rate variability, deceleration capacity, heart rate turbulence, morphological variability, and T-wave alternans, with promising preliminary findings.1As raised by Drs LeLorier and Ayalloore, the issue of defining an appropriate response to the finding of frequent premature ventricular beats remains a clinical dilemma. Although premature ventricular beats and nonsustained ventricular tachycardia are associated with an increased risk of poor cardiovascular outcomes, no therapies using electrocardiographic data to guide specific treatment have been shown to modify overall mortality risk. As LeLorier and Ayalloore remind us, the ability to suppress premature ventricular beats does not translate directly to improved clinical outcome. Overall, the data from the MERLIN-TIMI 36 study provide reassuring safety information regarding ranolazine in ischemic heart disease and are coupled with several hypothesis-generating observations of a potential clinical benefit specifically in those high-risk patients who are at greatest risk: patients with ventricular tachycardia lasting at least 8 beats,2 elevated natriuretic peptides,3 or reduced left-ventricular function.4 We agree that prospective clinical trials evaluating the effect of ranolazine on clinical arrhythmic events, including sudden cardiac death in a high-risk population, would be of substantial clinical interest.Benjamin M. Scirica, MD, MPHEugene Braunwald, MDChester M. Hedgepeth, MD, PhDJie Qin, MSDavid A. Morrow, MD, MPH TIMI Study Group Cardiovascular Division Department of Medicine Brigham and Women's Hospital, and Harvard Medical School Boston, MALuiz Belardinelli, MDWhedy Wang, PhD, MPHEwa Karwatowska-Prokopczuk, MD Gilead Science, Inc. Palo Alto, CAJindrich Spinar, MD University Hospital Brno Brno, Czech RepublicFreek W.A. Verheugt, MD Onze Lieve Vrouwe Gasthuis Amsterdam, The NetherlandsDisclosuresDr Scirica has received honoraria for educational presentations from CV Therapeutics (now Gilead Sciences, Inc.), Novartis, Merck & Co., Inc., Schering-Plough, Sanofi-aventis, Eli Lilly and Company, and Daiichi Sankyo, Inc. and has served as a consultant for AstraZeneca, Novartis, Cogentus, Gilead Sciences, and Shionogi & Co., Ltd. He is the recipient of an unrestricted research grant from the Michael Lerner Foundation. Dr Braunwald has received honoraria for educational presentations and consulting from CV Therapeutics. Dr Verheugt has received educational and research grants from Bayer, Roche, Eli Lilly and Company, and Boehringer Ingelheim, and has received honoraria for consultancies from Pharmacia & Upjohn Inc., Eli Lilly and Company, Merck & Co., Inc., and Bayer (The Netherlands). Drs Belardinelli and Prokopczuk and W. Wang are employees of and hold stocks/options in CV Therapeutics (Gilead Sciences). Dr Hedgepeth has received honoraria from Johnson & Johnson. Dr Spinar has received grants from the Ministry of Education of the Czech Republic. Dr Morrow has received honoraria for educational presentations from CV Therapeutics and Sanofi-aventis, has served as a consultant for GlaxoSmithKline and Sanofi-aventis, and has served on an advisory board for Genentech.References1. Syed Z, Scirica BM, Mohanavelu S, Morrow DA, Stultz CM, Guttag J. Association of heart rate turbulence, deceleration capacity and morphologic variability with sudden cardiac death following non-ST-elevation acute coronary syndrome: results from the MERLIN-TIMI 36 Trial. Circulation. 2010; 122:A15908.LinkGoogle Scholar2. Scirica BM, Braunwald E, Belardinelli L, Hedgepeth CM, Spinar J, Wang W, Qin J, Karwatowska-Prokopczuk E, Verheugt FW, Morrow DA. Relationship between nonsustained ventricular tachycardia after non-ST-elevation acute coronary syndrome and sudden cardiac death: observations from the metabolic efficiency with ranolazine for less ischemia in non-ST-elevation acute coronary syndrome- thrombolysis in myocardial infarction 36 (MERLIN-TIMI 36) randomized controlled trial. Circulation. 2010; 122:455–462.LinkGoogle Scholar3. Morrow DA, Scirica BM, Sabatine MS, de Lemos JA, Murphy SA, Jarolim P, Theroux P, Bode C, Braunwald E. B-type natriuretic peptide and the effect of ranolazine in patients with non-ST-segment elevation acute coronary syndromes: observations from the MERLIN-TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary-Thrombolysis In Myocardial Infarction 36) trial. J Am Coll Cardiol. 2010; 55:1189–1196.MedlineGoogle Scholar4. Scirica BM, Morrow DA, Hod H, Murphy SA, Belardinelli L, Hedgepeth CM, Molhoek P, Verheugt FW, Gersh BJ, McCabe CH, Braunwald E. Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial. Circulation. 2007; 116:1647–1652.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails April 12, 2011Vol 123, Issue 14 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.110.003525 Originally publishedApril 12, 2011 PDF download Advertisement SubjectsAcute Coronary SyndromesArrhythmiasMyocardial Infarction" @default.
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