Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillators: The RAID Trial

• Published in: Journal of the American College of Cardiology 2018-08, Vol.72 (6), p.636-645
• Main Authors: Zareba, Wojciech, Daubert, James P, Beck, Christopher A, Huang, David T, Alexis, Jeffrey D, Brown, Mary W, Pyykkonen, Kathryn, McNitt, Scott, Oakes, David, Feng, Changyong, Aktas, Mehmet K, Ayala-Parades, Felix, Baranchuk, Adrian, Dubuc, Marc, Haigney, Mark, Mazur, Alexander, McPherson, Craig A, Mitchell, L Brent, Natale, Andrea, Piccini, Jonathan P, Raitt, Merritt, Rashtian, Mayer Y, Schuger, Claudio, Winters, Stephen, Worley, Seth J, Ziv, Ohad, Moss, Arthur J
• Format: Article
• Language: English
• Subjects: Cardiac arrhythmia; Cardiology; Cardiomyopathy; Cardiovascular diseases; Clinical trials; Confidence intervals; Constipation; Death; Defibrillators; Drug dosages; FDA approval; Fibrillation; Heart failure; Hospitalization; Ischemia; Mortality; Patients; Prevention; Quality of life; Questioning; Randomization; Risk; Risk groups; Secondary analysis; Sodium; Tachycardia; Therapy; Ventricle; Ventricular fibrillation
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.04.086

Ventricular tachycardia (VT) and ventricular fibrillation (VF) remain a challenging problem in patients with implantable cardioverter-defibrillators (ICDs). This study aimed to determine whether ranolazine administration decreases the likelihood of VT, VF, or death in patients with an ICD. 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. 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. 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).