Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillators: The RAID Trial
Daubert, J P; Beck, C A; Huang, D T; Alexis, J D; Brown, M W; McNitt, S; Aktas, M K; Ayala-Parades, F; McPherson, C A; Piccini, J P; Rashtian, M Y; Worley, S J; Zareba, W; Pyykkonen, K; Buttaccio, A; Perkins, E; DeGrey, D; Robertson, S; Moss, A J; Brown, M; Lansing, R; Oberer, A; Polonsky, B; Ross, V; Papernov, A; Schleede, S; Beck, C; Oakes, D; Feng, C; McNitt, S S; Hall, W J; Moss, A; Daubert, J; Huang, D; Winters, S; Schuger, C; Haigney, M; Piccini, J; Alexis, J; Chen, L; Miller, A; Richeson, J F; Rosero, S; Kutyifa, V; Shah, A; Lamas, G; Cohn, F; Harrell, F; Pina, I; Poole, J; Sullivan, M; Lathrop, D; Geller, N; Boineau, R; Trondell, J; Cooper, L; Itturiaga, E; Gottlieb, C; Greer, S; Perzanowski, C; McPherson, C; Hedgepeth, C; Assal, C; Salam, T; Woollett, I; Tomassoni, G; Ayala-Paredes, F; Russo, A; Punnam, S; Sangrigoli, R; Sloan, S; Kutalek, S; Sun, A; Lustgarten, D; Monir, G; Haithcock, D; Sorrentino, R; Cannom, D; Kluger, J; Varanasi, S; Rashtian, M; Philippon, F; Berger, R; Mazzella, M; Lessmeier, T; Silver, J; Worley, S; Bernabei, M; Esberg, D; Dixon, M; LeLorier, P; Greenberg, Y; Essebag, V; Venkataraman, G; Shinn, T; Dubuc, M; Turitto, G; Henrikson, C; Mirro, M; Raitt, M; Baranchuk, A; O'Neill, G; Lockwood, E; Vloka, M; Hurwitz, J; Mead, R H; Somasundarum, P; Aziz, E; Rashba, E; Budzikowski, A; Cox, M; Natale, A; Chung, E; Ziv, O; McGrew, F; Tamirisa, K; Greenspon, A; Estes, M; Taylor, S; Janardhanan, R; Mitchell, L B; Burke, M; Attari, M; Mikaelian, B; Hsu, S; Conti, J; Mazur, A; Shorofsky, S; Rosenthal, L; Sakaguchi, S; Wolfe, D; Flaker, G; Saba, S; Aktas, M; Mason, P; Shalaby, A; Musat, D; Abraham, R; Ellenbogen, K; Fellows, C; Kavesh, N; Thomas, G; Hemsworth, D; Williamson, B
Background: Ventricular tachycardia (VT) and ventricular fibrillation (VF) remain a challenging problem in patients with implantable cardioverter-defibrillators (ICDs). Objectives: This study aimed to determine whether ranolazine administration decreases the likelihood of VT, VF, or death in patients with an ICD. Methods: This was double-blind, placebo-controlled clinical trial in which high-risk ICD patients with ischemic or nonischemic cardiomyopathy were randomized to 1,000 mg ranolazine twice a day or placebo. The primary endpoint was VT or VF requiring appropriate ICD therapy or death, whichever occurred first. Pre-specified secondary endpoints included ICD shock for VT, VF, or death and recurrent VT or VF requiring ICD therapy. Results: Among 1,012 ICD patients (510 randomized to ranolazine and 502 to placebo) the mean age was 64 +/- 10 years and 18% were women. During 28 +/- 16 months of follow-up there were 372 (37%) patients with primary endpoint, 270 (27%) patients with VT or VF, and 148 (15%) deaths. The blinded study drug was discontinued in 199 (39.6%) patients receiving placebo and in 253 (49.6%) patients receiving ranolazine (p = 0.001). The hazard ratio for ranolazine versus placebo was 0.84 (95% confidence interval: 0.67 to 1.05; p = 0.117) for VT, VF, or death. In a pre-specified secondary analysis, patients randomized to ranolazine had a marginally significant lower risk of ICD therapies for recurrent VT or VF (hazard ratio: 0.70; 95% confidence interval: 0.51 to 0.96; p = 0.028). There were no other significant treatment effects in other pre-specified secondary analyses, which included individual components of the primary endpoint, inappropriate shocks, cardiac hospitalizations, and quality of life. Conclusions: In high-risk ICD patients, treatment with ranolazine did not significantly reduce the incidence of the first VT or VF, or death. However, the study was underpowered to detect a difference in the primary endpoint. In prespecified secondary endpoint analyses, ranolazine administration was associated with a significant reduction in recurrent VT or VF requiring ICD therapy without evidence for increased mortality. (Ranolazine Implantable Cardioverter-Defibrillator Trial [RAID]; NCT01215253)
EMBASE:2000974690
ISSN: 0735-1097
CID: 3221672