The Clinical Use of Ivabradine
- Koruth JS, Lala A, Pinney S, Reddy VY, Dukkipati SR.
- The Clinical Use of Ivabradine. J Am Coll Cardiol 2017;70:1777-1784.
The following are key points to remember about the clinical use of ivabradine:
- Ivabradine is a drug with unique electrophysiological effects, best characterized by its negative chronotropic effect on the sinoatrial node.
- The clinical use of ivabradine is predicated on its mechanism of action on sinoatrial nodal tissue where it selectively inhibits the funny current (If) and results in a decrease in heart rate.
- It is distinct from other pharmacological agents known to have benefit in heart failure with reduced ejection fraction in that it does not target the neurohormonal system.
- Ivabradine’s overall favorable safety profile can be attributed to electrophysiological actions that are limited to the sinoatrial node (inhibition of If) and the absence of clinically significant nonelectrophysiological effects.
- The most common cardiovascular adverse reaction is bradycardia, which may result in symptoms such as dizziness and/or fatigue. A meta-analysis has also demonstrated a 15% increase in relative risk for atrial fibrillation.
- The incidence of atrial fibrillation must, however, be considered and addressed, given its consequences, and may, in part, be related to ivabradine’s bradycardic effects in certain patient populations.
- Ivabradine is best viewed by clinicians as a second-line drug for systolic heart failure and chronic stable angina, with the understanding that it has received different region-based approvals for patients with specific clinical profiles.
- Ivabradine’s most frequent application in electrophysiology is for the treatment of inappropriate sinus tachycardia. It should be noted that its use for inappropriate sinus tachycardia is not an European Medicines Agency/Food and Drug Administration–approved indication for ivabradine.
- Its role in the treatment of inappropriate sinus tachycardia and other electrophysiological disorders, although encouraging, lacks the support of large studies and currently remain unapproved indications.
- Additional prospective and randomized evaluations are needed before recommending an expanded role for ivabradine.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Stable Ischemic Heart Disease, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Chronic Heart Failure, Chronic Angina
Keywords: Angina, Stable, Arrhythmias, Cardiac, Atrial Fibrillation, Benzazepines, Bradycardia, Dizziness, Electrophysiology, Heart Failure, Heart Failure, Systolic, Heart Rate, Sinoatrial Node, Stroke Volume, Tachycardia, Sinus, Vertigo
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