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• W2895394967 abstract "SESSION TITLE: Critical Care 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Ranolazine is a novel oral antianginal agent that has been approved for patients with refractory angina pain in stable ischemic heart disease. In addition to its antianginal action, it has been noted to have profound antiarrhythmic properties. Trials have shown potential use of Ranolazine in preventing Atrial Fibrillation (AF) after electrical cardioversion and Non-ST segment elevation myocardial infarction respectively(1,2). However, the data on its use in sepsis-induced AF as a therapeutic agent is limited. CASE PRESENTATION: A 55-year-old male with a past medical history of paroxysmal AF CHADS-2 score of 1, recurrent central line-associated bloodstream infection, hypertension, hyperlipidemia and extensive abdominal surgeries presented with septic shock. He denied use of tobacco, alcohol, and illicit drugs. Home medications include Atorvastatin, Aspirin, Lisinopril, and Diltiazem. He was adequately treated with fluid resuscitation, vasopressors, and antibiotics. During this hospital stay, he developed AF up to 140 beats per minute (bpm) the cause of which was attributed to underlying sepsis. He was rate controlled with diltiazem bolus followed by drip and eventually converted to normal sinus rhythm (NSR) with rapid 150 mg amiodarone bolus but reverted back to AF and became hypotensive. It was at that point Ranolazine 1000 mg twice daily was tried as it was relatively safer option in terms of maintaining blood pressure. His heart rate dropped to 70 bpm within one hour and his rhythm converted to normal sinus rhythm. The Diltiazem drip was stopped and the patient was maintained at 60 mg Diltiazem 60 mg every 6 hours. He was eventually discharged on oral Diltiazem and Ranolazine and remained in NSR on 1 and 2 month follow up visits. DISCUSSION: To our knowledge, this is the first case reporting on the use of Ranolazine for prevention and treatment of paroxysmal AF where underlying trigger could be sepsis. The RAFFAELLO trial, the HARMONY trial, and Koskinas et al reported benefits of using Ranolazine in AF. They do not comment on the potential use of Ranolazine in sepsis-induced AF. Aoki et al. demonstrated that higher concentration of cytokines and inflammatory markers in sepsis might be triggering the AF. They exert their effect by causing shortening of action potential via reduced L-type calcium current and increased delayed rectifier potassium current. At higher concentrations, Ranolazine inhibits the rapid delayed rectifier potassium current (IKr) that leads to prolongation of the action potential and increases the refractory period in atrial tissue (3). This might be the reason that Ranolazine worked so effectively in our patient who had active sepsis and high inflammatory burden. CONCLUSIONS: In conclusion, this case develops possible link of treatment of sepsis-induced AF with Ranolazine and needs to be further analyzed in large-scale randomized studies. Reference #1: De Ferrari GM, Maier LS, Mont L, et al. Ranolazine in the treatment of atrial fibrillation: results of the dose-ranging RAFFAELLO (Ranolazine in Atrial Fibrillation Following an ELectricaL CardiOversion) study. Heart Rhythm. 2015;12:872-878. Reference #2: Scirica BM, Belardinelli L, Chaitan BR, et al. Effect of ranolazine on atrial fibrillation in patients with non-ST elevation acute coronary syndromes: observations from the MERLINTIMI 36 trial. Europace. 2015;17:32-37. Reference #3: Hasenfuss G, Maier LS. Mechanism of action of the new anti-ischemia drug ranolazine. Clin Res Cardiol. 2008;97(4):222-6. DISCLOSURES: no disclosure on file for Muhammad Farooq; No relevant relationships by Abhas Khurana, source=Web Response No relevant relationships by Gaurav Manek, source=Web Response No relevant relationships by Usama Nasir, source=Web Response" @default.
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• W2895394967 date "2018-10-01" @default.
• W2895394967 modified "2023-10-18" @default.
• W2895394967 title "THERAPEUTIC USE OF RANOLAZINE FOR ATRIAL FIBRILLATION IN SEPTIC SHOCK" @default.
• W2895394967 doi "https://doi.org/10.1016/j.chest.2018.08.319" @default.
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