Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience

Abstract

Background: Ivabradine is a selective I f channel blocker that reduces heart rate without affecting other cardiovascular functions. In case reports and case series, it was shown to improve symptoms in patients with postural tachycardia syndrome (POTS). Methodology and results:This retrospective study examined patients who were diagnosed with POTS and received ivabradine as part of their treatment. Forty-nine patients (47 females, 95.9%) received ivabradine. The average age was 35.1 ± 10.35 years. The most common symptoms were palpitations and lightheadedness and both improved significantly, 88.4% and 76.1% response rate, respectively. A total of 38 patients reported improvement in their symptoms. In addition, ivabradine resulted in an objective decrease in sitting and standing heart rate (78.1 ± 10.7 vs 72.5 ± 7.6, P-value: 0.01) and (107.4 ± 14.1 vs 95.1 ± 13.7, P-value: < 0.001), respectively, with no significant change in blood pressure. The most common reported side effect was luminous phenomena/visual brightness occurring in nine patients. However, none of the patients stopped ivabradine due to side effects. Conclusion:Our study shows that ivabradine is likely to be effective in treating patients with POTS. Nearly 78% of our cohort reported a significant improvement in symptoms with no major adverse effects reported. A future randomized, placebo-controlled trial is warranted.

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance

“…Drug therapies might be synergistic, with varied but complementary mechanisms of action. Most common medications used in the management of POTS include midodrine, [20][21][22] propranolol, 17,23,24 pyridostigmine, 25,26 fludrocortisone, 27,28 ivabradine, [29][30][31] clonidine, 32 and intermittent intravenous (I.V.) normal saline infusions.…”

“…We recommend that patients with POTS be managed by a primary care physician for the diagnosis, appropriate exclusion of alternative diagnoses, and initial treatments (Strong Recommendation, Very-Low-Quality Evidence). 31. We recommend that referral to a specialty clinic for POTS should be considered when there is diagnostic uncertainty, or a poor response to nonpharmacological and initial pharmacological treatments (Strong Recommendation, Very Low-Quality Evidence).…”

Pediatric dysautonomia: Much‐maligned, often overmedicated, but not as complex as you think

“…Ivabradine has recently been recognized as helpful for adult patients with dysautonomia who cannot tolerate beta-blockers. 15,16 It is common for patients to seek care from multiple subspecialists for symptomatic relief. This would include neurologists for headaches, rheumatologists and orthopedists for musculoskeletal pains, gastroenterologists for nausea and early satiety, urologists for urinary tract infections and urinary retention, sleep specialists for insomnia, behavioral pediatricians due to inability to concentrate in school, and psychiatrists for anxiety and or depression.…”

Is the answer just beneath the surface? And other updates on recent autonomic research

“…Funny channels underlie the cardiac "pacemaker" current, an inward current that flows though intermembrane cardiac proteins with mixed sodium and potassium permeability and play a vital but still incompletely understood role in cardiac rate generation. In the August 28th issue of Pacing Clinical Electrophysiology, Ruzieh and colleagues report on their experience with ivabradine in patients with POTS [4]. Forty-nine patients with POTS received ivabradine in their clinic.…”