Short-course of ranolazine prevents postoperative atrial fibrillation following coronary artery bypass grafting and valve surgeries

Background: Postoperative atrial fibrillation (POAF) is a common complication arising after coronary artery bypass grafting (CABG) and valve replacement or repair surgeries. POAF has been associated with increased mortality, morbidity and cost.

Methods: The study was conducted to evaluate the incidence of POAF following CABG, valve or combination surgeries when perioperative ranolazine (1,000 mg preoperatively, then 1,000 mg twice daily for 7 days or until discharge) was or was not added to standard therapy.

Results: A total of 205 patients were evaluated for POAF after CABG, valve or combination surgeries. POAF occurred less frequently in the ranolazine group compared with the non-ranolazine group in unmatched analysis (10.1 vs. 41.9 %, p < 0.0001). After adjusting for potential sources of bias through propensity-score matched-pair analysis and conditional logistic regression, ranolazine was an independent predictor of preventing POAF (p < 0.0001). There were no differences in bradycardia, new renal failure or neurological events between the two groups. Early, symptomatic hypotension occurred more frequently in the ranolazine group (p = 0.0004) although this difference did not persist after 72 h. No significant difference was found in the length of stay in the intensive care unit following cardiac surgery. While a significant difference was found in the hospital readmission rate for a cardiac cause within 30 days in the unmatched analysis (p = 0.046), this difference was nonexistent after matching (p = 0.39). No difference was found in 30-day cardiovascular mortality.

Conclusion: Adding ranolazine to standard therapy was independently associated with a significant decrease in POAF development after CABG, valve or combination surgeries.