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Background: The effect of ranolazine (RAN) on cardiac autonomic balance in congestive heart failure (CHF) was studied.  Methods: Fifty-four CHF patients were randomized to (1) open-label RAN (RANCHF) added to usual therapy vs.  (2) usual therapy (NORANCHF). Parasympathetic and sympathetic (P&amp;S) measurements were taken at baseline and at 12 months.  Results: A total of 16/27 (59%) patients in both groups had initially abnormal P&amp;S measures, including high sympathovagal balance (SB), cardiovascular autonomic neuropathy (CAN) or both. High SB normalized in 10/12 (83%) RANCHF patients vs. 2/11 (18%) NORANCHF patients. SB became high in 5/11 (45%) NORANCHF vs. 1/11 (9%) RANCHF patients. CAN improved in 4/6 (67%) RANCHF patients vs. 5/7 (45%) NORANCHF patients. CAN developed in 1/11 (9%) RANCHF vs. 4/11 (36%) NORANCHF patients. Since improved P&amp;S in RANCHF patients seemed independent of improved brain natriuretic peptide and impedance cardiography (BioZ) measurements, 5 day RAN was given to 30 subjects without CHF but with high SB or CAN. P&amp;S improved in 90% of these subjects.  Conclusions: RAN improves unfavorable P&amp;S activity in CHF possibly by a direct effect upon autonomic sodium channels.

Ranolazine Improves Autonomic Balance in Heart Failure when added to Guideline-Driven Therapy