Beneficial effects of ivabradine in atrial or ventricular arrhythmias

The Bradycardic Agent Ivabradine Acts as an Atypical Inhibitor of Voltage-Gated Sodium Channels

“…A weak frequency dependence may also serve as an explanation that changes in QRS duration by ivabradine were not rate-dependent ( Amstetter et al, 2021 ). In any case, ivabradine was recently shown to control catecholaminergic polymorphic ventricular tachycardia ( Vaksmann and Klug, 2018 ; Kohli et al, 2020 ) and junctional ectopic tachycardia ( Al-Ghamdi et al, 2013 ; Dieks et al, 2016 ; Kumar et al, 2017 ; Ergul et al, 2018 ; Ergul and Ozturk, 2018 ; Mert et al, 2018 ; Janson et al, 2019 ; Kumar et al, 2019 ). While some of these arrhythmias may be of automatic origin, potentially tied to the function of HCN channels, the antiarrhythmic activity of ivabradine could also stem from the inhibition of VGSCs, in particular under ischemic conditions and in the failing heart, when resting membrane potentials are substantially depolarized ( Bean et al, 1983 ) and channel block would be favored ( Figure 4 ).…”

“…Recent meta-analyses suggested an increased risk of atrial fibrillation associated with ivabradine treatment ( Martin et al, 2014 ; Tanboğa et al, 2016 ; Mengesha et al, 2017 ). On the other hand, ivabradine was able to control ventricular arrhythmias in catecholaminergic polymorphic ventricular tachycardia ( Vaksmann and Klug, 2018 ; Kohli et al, 2020 ) and junctional ectopic tachycardia ( Al-Ghamdi et al, 2013 ; Dieks et al, 2016 ; Kumar et al, 2017 ; Ergul et al, 2018 ; Ergul and Ozturk, 2018 ; Mert et al, 2018 ; Janson et al, 2019 ; Krishna et al, 2019 ; Kumar et al, 2019 ). Recently, ivabradine has also been considered as a rate control therapy for atrial fibrillation ( Moubarak et al, 2014 ; Kosiuk et al, 2015 ; Turley et al, 2016 ; Wongcharoen et al, 2016 ; Fossati et al, 2017 ), with a current clinical trial to test for this potential new indication ( Fontenla et al, 2019 ), and for other forms of atrial and ventricular tachyarrhythmias [e.g., ( Cohen et al, 2020 ; Kohli et al, 2020 )].…”