Effect of ranolazine on Tp-e interval, Tp-e/QTc, and P-wave dispersion in patients with stable coronary artery disease

Introduction: Ranolazine is an antianginal drug and also exhibits antiarrhythmic effect by affecting action potential time, refractory period, and repolarization reserve. We evaluated the effect of ranolazine therapy on myocardial repolarization parameters (Tp-e, QT, QTc intervals, Tp-e/QT, and Tp-e/QTc ratios), index of cardiac electrophysiological balance (iCEB) (QT/QRS, QTc/QRS) and P-wave dispersion (PWD) in patients with stable coronary artery disease (CAD). Methods: This study included 175 patients, aged between 35 and 90 years who were followed with stable CAD for at least 3 months. Ninety patients had been receiving ranolazine for at least 1 month, and 85 patients had never received ranolazine. All patients' basic demographic data, risk factors, medications, and echocardiographic parameters recorded. Myocardial repolarization parameters, P-wave times, and PWD were analyzed from 12 lead electrodes. Results: There was no variation between the groups in terms of basic demographic parameters and CAD risk factors. Tp-e interval (87.3 +/- 14.4 vs. 90.8 +/- 12.4 msn, P < .001), Tp-e/QT (0.22 +/- 0.04 vs. 0.23 +/- 0.03; P = .03), Tp-e/QTc (0.21 +/- 0.04 vs. 0.22 +/- 0.04 P = .001), and PWD (39.2 +/- 13.7 vs. 43.5 +/- 12.9 P = .028) were significantly lower in the ranolazine group. But iCEB was similar in both groups. In multivariate analysis after adjusted confounding factors such as age and BMI, Tp-e/QTc ratio, QTc, P-max, and PWD were found significantly in ranolazine group again. Conclusion: Tp-e/QTc ratio, QTc, P-max, and PWD were significantly lower in stable CAD patients under ranolazine therapy. In stable CAD patients, the prognostic significance of ranolazine for arrhythmic events requires further evaluation of these parameters through long-term follow-up and large-scale prospective studies.