Ivabradine in Postural Orthostatic Tachycardia Syndrome: Preliminary Experience in Children

Donne, Grazia Delle; Noguer, Ferrán Rosés; Till, Jan; Salukhe, Tushar V.; Prasad, Sanjay K.; Daubeney, Piers E.F.

doi:10.1007/s40256-017-0248-x

Cited by 21 publications

(21 citation statements)

References 21 publications

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“…These results are in keeping with the earlier study done by Donne et al, reporting clinical improvements of around 68% in children with postural orthostatic tachycardia syndrome. 11 Ivabradine is a selective inhibitor of the inward funny current that contributes to sinus node automaticity. Our knowledge of the inward funny current channel, located in the sino-atrial node, is primarily based on animal studies.…”

Section: Discussionmentioning

confidence: 99%

“…20 In clinical trials, transient enhanced brightness in a limited area of the visual field (phosphenes), excessive bradycardia, dizziness, and excessive fatigue are common side effects associated with ivabradine. 8,9,11,21 All patients were counselled in advance about these potential adverse effects. In our study, two uncommon side effects, excessive flushing, and joint pain/fatigue, were responsible for discontinuation of the medication in two patients.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Donne et al published a study looking at 22 children with postural orthostatic tachycardia syndrome treated with ivabradine and showed an improvement in symptoms in 68% of patients. 11 Our study was a retrospective study designed to further evaluate the use of ivabradine in paediatric population.…”

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confidence: 99%

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Ivabradine in children with postural orthostatic tachycardia syndrome: a retrospective study

et al. 2020

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AbstractBackground:Ivabradine is a unique medication that reduces the intrinsic heart rate by specifically blocking the inward funny current that controls the pacemaker activity of the sinus node. We conducted a retrospective cohort study to assess the efficacy of ivabradine in children suffering from postural orthostatic tachycardia syndrome.Methods:A chart review was conducted of patients less than 18 years of age who were diagnosed with postural orthostatic tachycardia syndrome who had received ivabradine as treatment from January 2015 to February 2019 at our institution. Twenty-seven patients (25 females, 92.5%) were identified for the study. The outcomes which were assessed included a change in the severity and frequency of symptoms, heart rate, and blood pressure before and after starting ivabradine.Results:There was an improvement in the symptoms of 18 (67%) out of 27 patients. The most notable symptom affected was syncope/presyncope with a reduction in 90%, followed by lightheadedness (85%) and fatigue (81%). The vital signs of the patients showed an overall significant lowering of the heart rate during sitting (89.7 ± 17.9 versus 73.2 ± 12.1; p-value <0.05) and standing (100.5 ± 18.1 versus 80.9 ± 10.1; p-value <0.05) without a significant change in the blood pressure. Two patients had visual disturbances (luminous phenomena). Severe bradycardia and excessive flushing were seen in two patients, respectively. Another one patient reported joint pain and fatigue.Conclusion:This study indicates that 67% of children treated with ivabradine report an improvement in symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ivabradine in children with postural orthostatic tachycardia syndrome: a retrospective study

et al. 2020

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“…Ivabradine is a theoretically desirable treatment for POTS because of its specific effects on lowering HR without affecting BP. Three studies have evaluated the effects of ivabradine in POTS (Delle Donne et al, 2018;McDonald et al, 2011;. In these studies, ivabradine was generally well tolerated and decreased resting and orthostatic HR in most POTS patients without altering blood pressure (Delle Donne et al, 2018;McDonald et al, 2011;.…”

Section: Ivabradinementioning

confidence: 99%

Pharmacotherapy for postural tachycardia syndrome

Miller

Raj

2018

Autonomic Neuroscience

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“…Based upon this model the therapeutic consequences become clear: If the "panic peak" is caused by a POTS, we should treat according the current standards of pharmacotherapy: beta-blocker, midodrine, ivabradine, fludrocortisone. POTS treatment should be individualized to the underlying pathophysiology [12][13][14][15]. If POTS is related to a funny channel induced left ward shift of the NN-histogram during refeeding ivabradine seems to be the therapy of choice.…”

Section: Our Pathophysiological Model Of Heart Rate Regulation In Patmentioning

confidence: 99%

Heart rate regulation in patients with anorexia nervosa

Baumann¹,

Buchhorn²,

Willaschek³

2019

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Background and Aims: To examine the effects of starvation and nutritional refeeding on heart rate variability (HRV) and heart rate in adolescents with Anorexia Nervosa. Method: For this publication we illustrate 3 precedential cases to explain our model of heart rate regulation in patients with Anorexia Nervosa. Results: The linear relationship between the range of normal RR-intervals, global heart rate variability (SDNN) and mean heart rate is explainable by the slope of the diastolic depolarization of sinus node cells, regulated by the funny channels. We demonstrate the relationship between caloric intake, heart rate and heart rate variability which is better explained by the regulation of the funny channels than by the autonomic nervous system. However, the impaired heart rate regulation induces dysautonomia, demonstrated in two patients who develop postural orthostatic tachycardia syndrome (POTS). Based upon this model we explain the therapeutics effects of beta blockers, midodrine and ivabradine in these patients. Discussion: Our model of heart rate regulation in patients with Anorexia Nervosa explains dysautonomia in these patients and the effect of refeeding on heart rate regulation. Treatment of the impaired heart rate regulation in these patients with beta blockers, midodrine and ivrabradine can improve the oftenunsatisfactory therapy results.

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Ivabradine in Postural Orthostatic Tachycardia Syndrome: Preliminary Experience in Children

Abstract: From this initial experience, ivabradine is safe in patients younger than 18 years with POTS. We observed improvement of symptoms in 68% and phosphenes in less than 5%. Further studies are needed to assess the safety in a randomized control setting.

Cited by 21 publications

References 21 publications

Ivabradine in children with postural orthostatic tachycardia syndrome: a retrospective study

Ivabradine in children with postural orthostatic tachycardia syndrome: a retrospective study

Pharmacotherapy for postural tachycardia syndrome

Heart rate regulation in patients with anorexia nervosa

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