Is ivabradine a wonder drug for atypical POTS?

Cheema, Muhammad Arslan; Zain, Muhammad; Ullah, Waqas; Cheema, Khadija

doi:10.1136/bcr-2018-227789

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…(eight out of nine) cases with female patients, and this high female-to-male ratio is consistent with the previously published literature (Table 4) [12][13][14]16]. The mean age of the patients with symptoms of POTS and sympathetic dysfunction has been found to be 26.8 years, ranging from 17 to 42 years [36][37][38][39][40][41][42][43][44]. This figure is also coherent with the past studies of ivabradine assessment, in which the affected individuals were young and middle-aged adults.…”

Section: Pots and Ivabradine: A Review Of Case Reportssupporting

confidence: 88%

“…In other case reports, a complete resolution of syncopal episodes was also observed during the course of follow-up while the patient remained asymptomatic [39,41]. Almost all the other cases reported improvement in standing and supine HRs with a notable recovery from palpitations, tachycardia, and syncope [36,37,42,44].…”

Section: Pots and Ivabradine: A Review Of Case Reportsmentioning

confidence: 62%

“…In some cases, beta-blockers were discontinued due to poor tolerance whereas Oztunc et al reported changing the treatment option to ivabradine due to no effective outcome from metoprolol and midodrine [36][37][38]40]. Another patient complied with the advice of maintaining hydration and taking fludrocortisone for several months only for her symptoms to persist [42].…”

Section: Pots and Ivabradine: A Review Of Case Reportsmentioning

confidence: 99%

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Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature

Tahir¹,

Arif²,

Majid³

et al. 2020

Cureus

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Section: Pots and Ivabradine: A Review Of Case Reportssupporting

confidence: 88%

Section: Pots and Ivabradine: A Review Of Case Reportsmentioning

confidence: 62%

Section: Pots and Ivabradine: A Review Of Case Reportsmentioning

confidence: 99%

See 1 more Smart Citation

Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature

Tahir¹,

Arif²,

Majid³

et al. 2020

Cureus

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show abstract

“…Usually given the dose of 2.5 to 20 mg/day in two divided doses titrated to achieve resting supine heart rate between 50/min to 70/min. It improves the symptoms of orthostatic tachycardia in POTS patients [78][79][80][81][82].…”

Section: Pharmacological Managementmentioning

confidence: 94%

COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review

Mallick¹,

Goyal²,

Chourasia³

et al. 2023

Cureus

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POTS (Postural Orthostatic Tachycardia Syndrome) is a multisystem disorder characterized by the abnormal autonomic response to an upright posture, causing orthostatic intolerance and excessive tachycardia without hypotension. Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Prominent symptoms of POTS include fatigue, orthostatic intolerance, tachycardia, and cognitive impairment. The exact mechanisms of post-COVID-19 POTS are unclear. Still, different hypotheses have been given, including autoantibody production against autonomic nerve fibers, direct toxic effects of SARS-CoV-2, or sympathetic nervous system stimulation secondary to infection. Physicians should have a high suspicion of POTS in COVID-19 survival when presented with symptoms of autonomic dysfunction and should conduct diagnostic tests like the Tilt table and others to confirm it. The management of COVID-19-related POTS requires a comprehensive approach. Most patients respond to initial non-pharmacological options, but when the symptoms become more severe and they do not respond to the non-pharmacological approach, pharmacological options are considered. We have limited understanding and knowledge of post-COVID-19 POTS, and further research is warranted to improve our understanding and formulate a better management plan.

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“…In 2015, the HRS (Heart Rhythm Society) considered ivabradine as promising for treating patients with inappropriate sinus tachycardia (IST) [13], followed by a recommendation for ivabradine by the ACC (American College of Cardiology) in 2016 [14]-though only one small randomized controlled study has yet supported beneficial effects [21]. Although still not approved for this indication, recent ESC guidelines [15] also recommend ivabradine alone or in combination with a beta-blocker in symptomatic patients with IST, for the treatment of focal atrial tachycardia or for postural orthostatic tachycardia syndrome (POTS), a condition considered as common cause for orthostatic intolerance in women between 15 and 25 years [20,22] (Fig. 2).…”

Section: Treatment Indicationsmentioning

confidence: 99%

Ivabradine use in pregnant women—treatment indications and pregnancy outcome: an evaluation of the German Embryotox database

Hoeltzenbein

Lehmann

Beck

et al. 2021

Eur J Clin Pharmacol

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Purpose Ivabradine has been approved for the treatment of chronic heart failure and chronic stable angina pectoris in Europe. Based on adverse outcomes of reproductive animal studies and the lack of human data, ivabradine is considered contraindicated during pregnancy. The aim of this observational study is to analyse ivabradine use before and during pregnancy. Methods We evaluated all ivabradine-related requests to the German Embryotox Institute from 2007 to 2019. Exposed pregnancies were analysed as to their outcome. Results Off-label use for supraventricular tachycardia was frequent in women of childbearing age. Of 38 prospectively ascertained pregnancies with ivabradine exposure and completed follow-up, 32 resulted in live births, 3 in spontaneous abortions, and 3 were electively terminated. One neonate presented with major birth defects (atrial septal defect and cleft palate). In 33/38 patients, ivabradine was discontinued after confirmation of pregnancy without cardiac deterioration and 5/38 women continued ivabradine throughout pregnancy. In addition, there were 3 retrospectively reported pregnancies including one major birth defect (tracheal atresia). Conclusion This case series represents the largest cohort of ivabradine-exposed pregnancies, published so far. According to our findings, ivabradine appears not to be a major teratogen. However, established drugs of choice with strong evidence of low risk for the unborn should be preferred in women planning pregnancy. After inadvertent exposure during pregnancy or lack of treatment alternatives, fetal ultrasound for structural anomalies and growth restriction is recommended. In addition, close monitoring is necessary in pregnant women with supraventricular arrhythmias or cardiac disease.

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Is ivabradine a wonder drug for atypical POTS?

Cited by 5 publications

References 14 publications

Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature

Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature

COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review

Ivabradine use in pregnant women—treatment indications and pregnancy outcome: an evaluation of the German Embryotox database

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