Ivabradine Improves Heart Rate Variability in Patients with Nonischemic Dilated Cardiomyopathy

Abstract

BackgroundIvabradine is a novel specific heart rate (HR)-lowering agent that improves event-free survival in patients with heart failure (HF).ObjectivesWe aimed to evaluate the effect of ivabradine on time domain indices of heart rate variability (HRV) in patients with HF.MethodsForty-eight patients with compensated HF of nonischemic origin were included. Ivabradine treatment was initiated according to the latest HF guidelines. For HRV analysis, 24-h Holter recording was obtained from each patient before and after 8 weeks of treatment with ivabradine.ResultsThe mean RR interval, standard deviation of all normal to normal RR intervals (SDNN), the standard deviation of 5-min mean RR intervals (SDANN), the mean of the standard deviation of all normal-to-normal RR intervals for all 5-min segments (SDNN index), the percentage of successive normal RR intervals exceeding 50 ms (pNN50), and the square root of the mean of the squares of the differences between successive normal to normal RR intervals (RMSSD) were low at baseline before treatment with ivabradine. After 8 weeks of treatment with ivabradine, the mean HR (83.6 ± 8.0 and 64.6 ± 5.8, p < 0.0001), mean RR interval (713 ± 74 and 943 ± 101 ms, p < 0.0001), SDNN (56.2 ± 15.7 and 87.9 ± 19.4 ms, p < 0.0001), SDANN (49.5 ± 14.7 and 76.4 ± 19.5 ms, p < 0.0001), SDNN index (24.7 ± 8.8 and 38.3 ± 13.1 ms, p < 0.0001), pNN50 (2.4 ± 1.6 and 3.2 ± 2.2 %, p < 0.0001), and RMSSD (13.5 ± 4.6 and 17.8 ± 5.4 ms, p < 0.0001) substantially improved, which sustained during both when awake and while asleep.ConclusionOur findings suggest that treatment with ivabradine improves HRV in nonischemic patients with HF.

Beat Rate Variability in Murine Embryonic Stem Cell-Derived Cardiomyocytes: Effect of Antiarrhythmic Drugs

“…Clinical studies have documented that the administration of Ivabradine to patients suffering from nonischemic heart failure enhances time domain measures of HRV [15]. At the same time, an in vitro study, using human ESC-derived cardiomyocytes, concluded that 10 -6 M Ivabradine does not affect BRV [6].…”

“…Several studies investigated the effects of antiarrhythmic drugs on HRV in diseased as well as healthy individuals. Ivabradine, Verapamil and Sotalol, for instance, have been reported to increase HRV parameters in patient groups suffering from various cardiac diseases [14][15][16]. In contrast, Flecainide has been found to decrease HRV parameters in patients after acute myocardial infarction as well as in patients without structural heart disease [17,18].…”

Assessment of drug utilization pattern and rationality of drug use in treatment of dilated cardiomyopathy in a tertiary care teaching hospital of rural Bengal

“…Although Atenolol has been used in some cases, Metoprolol or Carvedilol remains a more rational choice of beta blocker in this case scenario. 14 Ivabradine was also found to be used in 1.54% cases in our study. This use is supported in recent literature due to its heart rate lowering effect.…”

“…This use is supported in recent literature due to its heart rate lowering effect. [14][15][16] Ivabradine has a beneficial effect in DCM especially in those who have heart rates not controlled with beta blockers. In few patients due to the heart rate lowering effect of beta blockers, syncope occurred and in those cases Digoxin was used as an alternative.…”

Ivadradine

“…Possible improvement in patient quality of life has also been noted. [6][7][8][9][10][11] Ivabradine may also decrease aortic stiffness after 1 year of treatment. 8 A few studies have also evaluated the potential role of ivabradine in the treatment of sinus tachycardia, postural orthostatic tachycardia syndrome, vasovagal syncope, and multiple organ dysfunction.…”