Efficacy of ranolazine in reducing complex premature ventricular contractions in a patient with mitral valve prolapse: a case report

Pharmacological options for treating arrhythmic mitral valve prolapse (aMVP) are limited and anecdotal. Ranolazine as an antiarrhythmic has yielded satisfactory outcomes in suppressing ventricular arrhythmias, but its role in the case of aMVP is unknown.

A 62-year-old female presented complaining of palpitations. ECG and the cardiac monitor showed very frequent and complex monomorphic premature ventricular contractions (PVCs), likely from the posteromedial papillary muscle. Cardiac MRI revealed the presence of mitral valve prolapse. Empirical treatment with ranolazine 1000 mg b.i.d. was initiated for antiarrhythmic purposes, with subjective clinical improvement and objective reduction of complex PVCs after 32 months of follow-up.

Papillary muscle PVCs are a common finding in patients with aMVP. Antiarrhythmic properties of ranolazine can be safely used in patients with contraindications to other interventions for the treatment of PVCs associated with mitral valve prolapse. The effect seems more evident on complex PVCs and ventricular tachycardia and can be attributed to an intrinsic use dependence of the drug; therefore, this treatment should be explored for selected cases. To the best of our knowledge, this is the first report of a case of improvement in PVCs following the administration of a high dose of ranolazine in a patient with aMVP. Future investigations on a larger scale should focus on whether ranolazine can be safely used as an alternative treatment to reduce the risks of ventricular arrhythmia and improve patients’ prognosis.