Safety of Amiodarone and Ranolazine Together in Patients With Angina (SARA)

Ranolazine is an effective and remarkably safe agent for the treatment of patients with chronic stable angina, but its inhibition of voltage gated potassium channels and electrocardiogram (EKG) corrected QT (QTc) prolongation properties have lead many to question its safety when combined with antiarrhythmic drugs. The investigators have proposed a study to determine the safety of ranolazine in patients with chronic stable angina who also take amiodarone. And are conducting a prospective single-center randomized single-blinded placebo controlled trial to run out of our large cardiology practice setting at Cardiovascular Consultants of Nevada. The hypothesis is that there will be no difference in the ventricular arrhythmia burden. The primary outcome will be the measurement of ventricular arrhythmia episodes on serial holter monitor and other serially acquired recordings (such as electrocardiogram, pacemaker or implantable defibrillator (ICD) data, and stress test data) over a three month trial period.

ranolazine 500mg twice daily, may increase to 1000 mg twice daily for therapy optimization in treating chronic stable angina

one pill twice daily, to increase to two pills twice daily to mirror standard ranolazine treatment strategy

primary outcome is the burden of ventricular arrhythmias measured on serial holter monitor recordings, stress test recordings, pacemaker or implantable defibrillator (ICD) recordings if available, at baseline and serially to trial completion.

The electrocardiogram (EKG) corrected QT (QTc) interval be quantitated at baseline and serially to trial completion

Inclusion Criteria: ischemic cardiac disease chronic anginal symptoms on amiodarone therapy for other cardiac conditions Exclusion Criteria: pregnant non-English speaking unstable angina baseline electrocardiogram (EKG) corrected QT (QTc)>490ms severe thyroid dysfunction heart block without a pacer system liver disease