Ivabradine in the Treatment of Inappropriate Sinus Tachycardia in Patients after Successful Radiofrequency Catheter Ablation of Atrioventricular Node Slow Pathway

Abstract

Ivabradine is an effective treatment option to reduce HR and symptoms in patients with IST after RF ablation of atrioventricular node slow pathway. The therapy with ivabradine is well tolerated even with maximum daily dose.

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary

“…The drug has no other hemodynamic effects aside from lowering the heart rate. As such, it has been investigated for use to reduce the sinus rate and improve symptoms related to IST (85)(86)(87)(88)(89)(90)(91)(92)(93).…”

Catheter ablation of the slow pathway as a treatment for severe sinus node dysfunction in a patient with incessant atrioventricular nodal reentry tachycardia

“…However, the autonomic theory was challenged by the observation that many patients suffering from inappropriate sinus tachycardia after RFA did not respond to β-blocker or calcium channel blocker treatment. 2 Thus, other unknown mechanisms could be responsible for the sinus node recovery time improvement described in this case report. 9 …”

“…Radiofrequency ablation (RFA) of slow/fast atrioventricular nodal reentry tachycardia (AVNRT) is considered to be an effective and safe procedure associated with rare complications, the most disturbing being the occurrence of atrioventricular (AV) block. 1 A few electrophysiological disorders have been reported after AVNRT ablation: inappropriate sinus tachycardia after either fast pathway or slow pathway (SP) ablation 2 and marked shortening of the antegrade fast pathway refractoriness after SP ablation. 3 , 4 …”

Beyond Heart Failure and Ischemic Heart Disease: A Scoping Review of Novel Uses of Ivabradine in Adults

“…Only five studies utilized a control or comparator group 13,21,22,27,28 . Although all studies included patients with IST, typically refractory to standard therapy, two studies investigated IST in patients following heart transplant and another following atrioventricular nodal reentrant tachycardia ablation 18,23,28 . Baseline values for both mean resting HR and mean average HR over 24 hours were consistent with diagnostic criteria for IST (> 100 bpm and > 90 bpm, respectively) in most of the studies, but two studies reported baseline values that did not satisfy these criteria 13,17 …”

“…Our search revealed 16 studies evaluating ivabradine for the treatment of IST in 383 adults (Table 1). 13–28 The majority of these studies (13) were observational cohort studies 14–21,23–26,28 . Only five studies utilized a control or comparator group 13,21,22,27,28 .…”