부산대학교 도서관

Introduction: Recurrent ventricular tachycardia and fibrillation (VT/VF) remain a challenging problem in patients with implantable cardioverter defibrillators (ICD). Ranolazine is a late sodium current blocker that may decrease the risk of VT/VF in high-risk ICD patients.Hypothesis: We hypothesized that recurrent VT/VF events will be reduced by ranolazine vs. placebo in high-risk ICD patients.Methods: RAID trial was double-blind, placebo controlled clinical trial in which high-risk ICD patients with ischemic or nonischemic cardiomyopathy were randomized 1:1 to ranolazine 1,000 mg bid or placebo. Secondary endpoints of the trial included recurrent VT/VF events and recurrent inappropriate ICD therapies.Results: There were 1,012 ICD patients enrolled in RAID: 510 randomized to ranolazine and 502 to placebo (the mean age: 64±10 years; 18% women). During mean 28±16 months of follow-up there were 1,714 VT/VF events requiring ICD therapy (ATP or Shock), 431 VT/VF events requiring ICD shock, and 1,495 VT events requiring only ATP therapy (all of them below 220 bpm). Regarding inappropriate therapies, there were 164 inappropriate ICD therapies (ATP or shock), 49 inappropriate ICD shocks, and 145 inappropriate ATPs. There were 148 (15%) death in the trial 78 (15.5%) in placebo arm and 90 (13.7%) in ranolazine arm (HR= 0.97; p=0.871). Table below shows hazard ratios for ranolazine vs. placebo for recurrent appropriate and inappropriate ICD therapies using Andersen-Gill models ignoring death as competing risk. The results are similar when using Fine-Grey models treating death as competing risk.Conclusions: Ranolazine reduced VT events (<220bpm) in high-risk ICD patients without increasing mortality. Recurrent VT/VF requiring ICD shocks were not affected by ranolazine treatment.