Lasting reduction of heart transplant tachycardia with ivabradine is effective and well tolerated: results of 48-month study

Abstract

The safety and efficacy of ivabradine applied in heart transplant (HTx) recipients with permanent sinus tachycardia (PST) has been depicted in previous short-term follow-up studies. We sought to investigate the long-term impact of ivabradine in this patient population. From May to November 2006, 29 HTx recipients with PST, who exhibited either contraindications or intolerance of beta-blocker medication or insufficient heart rate (HR) reduction on beta-blocker treatment, first received oral ivabradine treatment (5 mg bid). Ivabradine treatment was discontinued in three patients due to adverse events within the first week. In the remaining 26 patients, resting HR was significantly lowered from 106.8 ± 9.2 at baseline to 83.2 ± 5.1 bpm after 3 months (p < 0.001). This effect remained stable in the long-term follow-up (82.1 ± 11.8 bpm after 4 years), whilst blood pressure was not affected. Apart from the corrected QT interval (QTc), there were no significant changes in ECG. The elongated QTc at baseline (469.4 ± 29.5 ms) decreased to 444.3 ± 33.1 ms after 3 months ivabradine treatment (p < 0.001). A decrease in QTc until month 9 was observed, followed by a partial increase to the upper limit of the normal value. Neither allograft rejection nor changes in left ventricular ejection fraction were observed over the follow-up period. In conclusion, ivabradine appears to be a safe and feasible long-term therapeutic option for HTx recipients with PST. It reduced the resting HR without impairment of blood pressure, myocardial contractility and cardiac conduction. The prognostic value of normalised QTc following ivabradine administration requires further observation.

Is There a Role for Ivabradine Beyond its Conventional Use?

“…Zhang et al [50] during a 12-week follow-up of patients with HTx and chronic tachycardia demonstrated a significant reduction in HR (22%) after ivabradine treatment. These results were confirmed during a long follow-up [51].…”

Heart rate reduction for 36 months with ivabradine reduces left ventricular mass in cardiac allograft recipients: a long-term follow-up study

“…Despite the common occurrence of sinus tachycardia in heart transplant recipients, data regarding heart rate control in this distinct patient cohort are extremely limited 7,8,10,11. Ivabradine is a comparatively new therapeutic agent offering selective reduction of heart rate without the systemic side effects of beta-blockade.…”

“…As described previously, ivabradine, an I f channel antagonist, regulates pacemaker activity in the sinoatrial node, without the systemic side effects of beta-blocker therapy 7–9. However, long-term study data examining the association between heart rate and left ventricular mass in heart transplant recipients are insufficient 7,8,10,11. The current follow-up study examines the long-term tolerability, efficacy, safety, and echocardiographically determined effects on left ventricular mass after 36 months of ivabradine therapy in stable patients after heart transplantation presenting with symptomatic sinus tachycardia compared with a matched control group.…”

Lowering of Heart Rate before Computed Tomographic Coronary Angiography: Improvement in Image Quality and Role of Ivabradine

“…Beta-blockers (β-blockers) are the most widely used pre-medication to reduce HR and IV form has faster bioavailability. However, their use is limited due to possible contraindications in certain clinical situations (Tab 1) 17,18 .…”