Ranolazine in Preventing Ventricular Fibrillation During Aortic Valve Replacement in Patients with Low Ejection Fraction: A Single-Centre Retrospective Study

Author(s): Simopoulos Vasilios, Papadopoulos Eleftherios, Mitilis Vasilios, Tasoudis Vasilios, Dipla Konstantina, Hatziefthimiou Apostolia, Tsilimingas Nikolaos, Aidonidis Isaac

Objectives: Aortic valve replacement (AVR) is often associated with intraoperative ventricular fibrillation (VF) complicating early postoperative outcomes. Ca2+ triggering mechanisms induced by ischemia-reperfusion injury have been implicated as possible causes of this arrhythmia, however, the exact mechanisms remain unclear. The aim of this study was to investigate the role of late sodium current inhibition by ranolazine (RAN) in preventing VF in these patients.

Methods: We retrospectively examined 53 patients with aortic stenosis or insufficiency, receiving either mechanical or bioprosthetic AVR in the last two years. Of these, 29 (19 M/10 F, age 66.4 ± 11.3 y) were under treatment with RAN 500 mg × 2 daily (RAN group) and 24 (17 M/7 F, age 62.8 ± 17 y) had not been treated with RAN (control group). Internal defibrillation was usually applied at consecutively escalating energy levels to reset sinus rhythm in patients manifesting VF.

Results: At the time of aortic unclamping, 18 out of 29 patients (62%) in the control group and 6 out of 24 patients (25%) in the RAN group developed VF (P=0.007, χ2 test). Left ventricular ejection fraction (EF) was reduced in both groups (≤40%) with no significant between group differences (P=0.51). Cross-clamp time was 48.3 ± 9.6 min in the control group and 51.7 ± 8.8 min in the RAN group (P=0.09). QTc intervals measured postoperatively in the ICU after ECG stabilization, were within upper normal limits (430.3 ± 23.6 vs. 413.5 ± 20.2 ms, in control and RAN group, respectively; P= 0.008). The Tpeak-Tend interval was significantly reduced in RAN vs controls (p<0.001).

Conclusion: Patients with low EF receiving RAN before AVR surgery, showed a 37% lower incidence of VF compared to the control group. This is possibly associated to the RAN&r

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