Risk-benefit assessment of ivabradine in the treatment of chronic heart failure

Abstract

Heart rate is not only a major risk marker in heart failure but also a general risk marker. Within the last few years, it has been demonstrated that reduction of resting heart rate to <70 bpm is of significant benefit for patients with heart failure, especially those with impaired left ventricular systolic function. Ivabradine is the first innovative drug synthesized to reduce heart rate. It selectively and specifically inhibits the pacemaker If ionic current, which reduces cardiac pacemaker activity. Therefore, the main effect of ivabradine therapy is a substantial lowering of heart rate. Ivabradine does not influence intracardiac conduction, contractility, or ventricular repolarization. According to the European Society of Cardiology guidelines, ivabradine should be considered in symptomatic patients (New York Heart Association functional class II–IV) with sinus rhythm, left ventricular ejection fraction ≤35%, and heart rate ≥70 bpm despite optimal treatment with a beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and a mineralocorticoid receptor antagonist. As shown in numerous clinical studies, ivabradine improves clinical outcomes and quality of life and reduces the risk of death from heart failure or cardiovascular causes. Treatment with ivabradine is very well tolerated and safe, even at maximal recommended doses.

Effects of Ivabradine on Cardiac Electrophysiology in Dogs with Age-Related Atrial Fibrillation

“…Ivabradine is an inhibitor of If in the sinoatrial node, and can reduce heart rate and cardiac efficiency. It is mainly used for the treatment of several cardiovascular diseases, including chronic heart failure and stable angina pectoris, in clinical practice [ 23 , 24 ]. As an ion channel inhibitor, Ivabradine could also have potential antiarrhythmic effects.…”