Ivabradine: a Selective If Current Inhibitor in the Treatment of Stable Angina

Abstract

The role of heart rate reduction in the management of myocardial ischemia and chronic stable angina is pivotal. However, broad use and appropriate dosing of commonly used rate-slowing drugs is limited by their poor tolerability. Ivabradine is a selective inhibitor of the If currents of the sinoatrial node cells. If currents activity determines the slope of the depolarization curve towards the threshold level controlling heart rate in patients with sinus rhythm. Ivabradine, a compound of the benzocyclobutane (S 16257), exhibits a unique specificity for the If current and has a more favorable profile of adverse reactions compared to other If inhibitors. Accordingly, ivabradine has been used in the treatment of stable angina, where it presented anti-anginal and anti-ischemic effects equivalent to the effects of atenolol and amlodipine. Clinical studies proved the efficacy of ivabradine in patients with stable angina, while clinical data are awaited to verify its probable value in the treatment of atrial tachyarrhythmias and tachycardia due to ventricular dysfunction. Thus, the clinical value of ivabradine, which has completed clinical development for stable angina, is expected to exceed its role in the treatment of myocardial ischemia. In this context, ivabradine, promising efficacious and safe pharmacological management of heart rate, is a huge step in cardiovascular therapeutics.

Ivabradine—The Final Crusader for Postoperative Junctional Ectopic Tachycardia, a Case Report with Literature Review

“…Ivabradine was approved by the European Medicines Agency in 2005. Ivabradine has been used in adult patients to reduce the heart rate alone in sinus tachycardia in the treatment of stable angina and heart failure [18] [19] [20] [21] [22] [23]. Ivabradine also decreases the ventricular rate in patients with atrial fibrillation by means of rate dependent slowing of conduction without causing myocardial depression [24].…”

Ivabradine for junctional ectopic tachycardia in post congenital heart surgery

“… 1 It is generally controlled with sedation, body cooling, correcting electrolyte abnormalities, optimizing ionotropes and sometimes using amiodarone. Ivabradine, which is a known drug used for lowering heart rate in angina and heart failure, 2 was used successfully by Saleh et al 3 and Jana et al 4 in combination with amiodarone to control heart rate in congenital JET. It works by inhibiting cardiac pacemaker current in normal sinus node as well as in AV node and bundle of His.…”

Potential New Indication for Ivabradine: Treatment of a Patient with Congenital Junctional Ectopic Tachycardia

“…At present, Ivabradine is not yet been approved for clinical use in Canada or the US. Ivabradine has been used to lower heart rate in isolation for the treatment of angina and heart failure . Recently, it has also been reported to successfully treat a left atrial tachycardia due to a automatic mechanism .…”