Ivabradine for treatment of tachyarrhythmias in children and young adults

Janson, Christopher M.; Tan, Reina Bianca; Iyer, Venkat; Vogel, R. Lee; Vetter, Victoria L.; Shah, Maully J.

doi:10.1016/j.hrcr.2019.03.007

Cited by 29 publications

(27 citation statements)

References 10 publications

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“…It seems likely that ivabradine could therefore be useful in patients with EAT too. There are first reports on the efficacy of Ivabradine to control EAT in adult patients as well as in older children and adolescents (6)(7)(8)(9). On this basis we started oral Ivabradine in our young patient and restored sinus rhythm within 2 days by a combination therapy with metoprolol.…”

Section: Discussionmentioning

confidence: 86%

“…In the pediatric age group there are currently only case reports and a few small case series published. While two case series demonstrated a promising effect with congenital junctional ectopic tachycardia (JET) in infants (4,5), reports on its application in EAT are limited to older children and adults (6)(7)(8)(9). Reports on the use of Ivabradine in infants or/and young children with EAT are scarce (9).…”

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confidence: 99%

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Ectopic Atrial Tachycardia in a 12-Month-Old Girl Treated With Ivabradine and Beta-Blocker, a Case Report

et al. 2020

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We report on a 12-month-old girl with an ectopic atrial tachycardia successfully treated with the combination of a beta blocking agent and Ivabradine that acts on cardiac pacemaker cells by selectively inhibiting the I f channel. Standard therapy had failed to control the tachycardia before. No side effects attributable to Ivabradine were noticed. Due to its mechanism of action Ivabradine is a promising novel agent for the therapy of tachycardia due to increased automaticity. Reports on the use of Ivabradine in young children or infants are rare, but show promising results for congenital junctional ectopic tachycardia. This report adds the second case of ectopic atrial tachycardia in this age group and novel treatment with Ivabradine to the literature.

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Section: Discussionmentioning

confidence: 86%

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confidence: 99%

Ectopic Atrial Tachycardia in a 12-Month-Old Girl Treated With Ivabradine and Beta-Blocker, a Case Report

et al. 2020

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“…Ivabradine has been utilised for the treatment of both ectopic atrial tachycardia and junctional ectopic tachycardia in children. [3][4][5] Both of these dysrhythmias have a mechanism of action based on increased automaticity. The drug is especially appealing in patients who have haemodynamic instability as ivabradine has a rather haemodynamically neutral profile compared to other intravenous anti-arrhythmics.…”

Section: Discussionmentioning

confidence: 99%

Ivabradine as a stabilising anti-arrhythmic agent for multifocal atrial tachycardia

Cohen

Shope

et al. 2020

Cardiol Young

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Multifocal atrial tachycardia has certain electrocardiographic similarities to atrial fibrillation. The mechanism of atrial fibrillation is heterogenous but in some cases may arise from a single ectopic driver with fibrillatory conduction to the rest of the atria. This has led to the speculation that multifocal atrial tachycardia may have a similar mechanistic unifocal site that disperses through the atrium in a fibrillatory pattern. Ivabradine has been reported to be efficacious in an adult with paroxysmal atrial fibrillation as well as in children with junctional or ectopic atrial tachycardias. This is the first report of successfully using ivabradine, a novel anti-arrhythmic If blocking agent, to convert multifocal atrial tachycardia in a 5-month-old critically ill infant to a pattern indicating a single ectopic atrial focus. This allowed the patient’s single atrial focus to be ablated with return to sinus rhythm and decannulation from ventriculoarterial extracorporeal membrane oxygenation. This case suggests that multifocal atrial tachycardia may arise from a single automatic focus with downstream fibrillatory conduction to the atria.

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“…Though not approved by the FDA, it is commonly used for the treatment of symptoms in patients with inappropriate sinus tachycardia (ACC/AHA/HRS expert consensus statement: Class IIa recommendation) 5 . Ivabradine has also been shown to be safe and effective in the treatment of enhanced automaticity‐mediated tachyarrhythmias such as junctional and atrial ectopic tachycardia in children 6 …”

Section: Discussionmentioning

confidence: 99%

“…Ventricular arrhythmias in CPVT patients are mediated by delayed afterdepolarizations induced by abnormal diastolic Ca 2+ leakage through mutant RYR2 channels, which is known to be potentiated by catecholamine release during exercise and beta‐adrenergic stimulation 6 . The precise mechanisms that may underlie efficacy of ivabradine in CPVT patient have not been defined; however, a possible hypothesis is suppression of SA nodal activity at rest and during exercise.…”

Section: Discussionmentioning

confidence: 99%

Ventricular arrhythmia suppression with ivabradine in a patient with catecholaminergic polymorphic ventricular tachycardia refractory to nadolol, flecainide, and sympathectomy

Kohli

Aziz

Beaser

et al. 2020

Pacing Clinical Electrophis

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Conventional treatment strategies for catecholaminergic polymorphic ventricular tachycardia (CPVT) include avoidance of strenuous exercise and competitive sports, drugs such as ß-blockers and flecainide and, cervical sympathectomy. An implantable cardioverter-defibrillator (ICD) has been utilized if the response to these strategies is inadequate; however, ICD use in CPVT patients, in addition to usual complications, is associated with an increased risk of life-threatening electrical storm. Ivabradine is a selective inhibitor of hyperpolarization-activated cyclic nucleotide-gated potassium channel 4 generated funny current (I f ), which has been shown to be efficacious in suppression of inappropriate sinus tachycardia, junctional tachycardia, atrial tachycardia, and ventricular ectopy in humans. We report an 18-year-old male with a severe CPVT phenotype refractory to flecainide, nadolol, and sympathectomy who exhibited suppression of ventricular arrhythmias after initiation of ivabradine. These findings are of importance as ivabradine could be an important add-on therapy in CPVT patients who are drug refractory or are unable to continue conventional therapies at the recommended doses. K E Y W O R D Scatecholaminergic polymorphic ventricular tachycardia, drug and sympathectomy refractory, ivabradine, malignant syncope, RYR2 exon 3 deletion

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Ivabradine for treatment of tachyarrhythmias in children and young adults

Cited by 29 publications

References 10 publications

Ectopic Atrial Tachycardia in a 12-Month-Old Girl Treated With Ivabradine and Beta-Blocker, a Case Report

Ectopic Atrial Tachycardia in a 12-Month-Old Girl Treated With Ivabradine and Beta-Blocker, a Case Report

Ivabradine as a stabilising anti-arrhythmic agent for multifocal atrial tachycardia

Ventricular arrhythmia suppression with ivabradine in a patient with catecholaminergic polymorphic ventricular tachycardia refractory to nadolol, flecainide, and sympathectomy

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