THE CONVERSION OF PAROXYSMAL OR INITIAL ONSET ATRIAL FIBRILLATION WITH ORAL RANOLAZINE: IMPLICATIONS FOR “PILL IN THE POCKET” APPROACH IN STRUCTURAL HEART DISEASE

• Oral anti-arrhythmic agents given at high doses (usually 75100% of the maintenance dose) has been used successfully to treat patients with atrial fibrillation (AF) of recent onset. • Due to pro-arrhythmic concerns, this “Pill-in-the-Pocket” (PITP) approach to AF has been limited to patients without structural heart disease (SHD). • Ranolazine is an anti-anginal agent which exerts its antianginal effect via an electrophysiologic mechanism; inhibition of the late INa+ current and attenuation of Na and Ca overload. • Ranolazine inhibits after-depolarizations and triggered activity (a mechanism of pulmonary vein firing) and extends the refractory period of atrial tissue. • Ranolazine decreased episodes of AF in the MERLIN Trial and has no known pro-arrhythmic effects. • We explored the use of ranolazine as a means to convert new or paroxysmal AF in patients with or without SHD with implications for a safer PITP approach to AF management.