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Barzilai M, Jacob G. The Effect of Ivabradine on the Heart Rate and Sympathovagal Balance in Postural Tachycardia Syndrome Patients. Rambam Maimonides Med J. 2015;6(3)doi: 10.5041/RMMJ.10213.
Barzilai, M., & Jacob, G. (2015). The Effect of Ivabradine on the Heart Rate and Sympathovagal Balance in Postural Tachycardia Syndrome Patients. Rambam Maimonides medical journal, 6(3), . https://doi.org/10.5041/RMMJ.10213
Barzilai, Merav, and Jacob, Giris. "The Effect of Ivabradine on the Heart Rate and Sympathovagal Balance in Postural Tachycardia Syndrome Patients." Rambam Maimonides medical journal vol. 6,3 (2015). doi: https://doi.org/10.5041/RMMJ.10213
Barzilai M, Jacob G. The Effect of Ivabradine on the Heart Rate and Sympathovagal Balance in Postural Tachycardia Syndrome Patients. Rambam Maimonides Med J. 2015 Jul 30;6(3). doi: 10.5041/RMMJ.10213. PMID: 26241226; PMCID: PMC4524401.
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Rambam Maimonides Med J. 2015 Jul 30;6(3). doi: 10.5041/RMMJ.10213.

The Effect of Ivabradine on the Heart Rate and Sympathovagal Balance in Postural Tachycardia Syndrome Patients.

Rambam Maimonides medical journal

Merav Barzilai, Giris Jacob

Affiliations

  1. J. Recanati Autonomic Dysfunction Center, Tel Aviv "Sourasky" Medical Center, Tel Aviv, Israel.
  2. Medicine F, Tel Aviv "Sourasky" Medical Center, Tel Aviv, Israel.
  3. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 26241226 PMCID: PMC4524401 DOI: 10.5041/RMMJ.10213

Abstract

BACKGROUND: Postural tachycardia syndrome (POTS) is a common form of chronic orthostatic intolerance. The remarkable increase in heart rate (HR) upon standing is the hallmark of this syndrome. Treatment of POTS patients is challenging and includes drugs that slow the HR. Ivabradine is a selective If channel blocker designed to slow the HR, as an anti-anginal agent. In view of its ability to slow the HR, we posited that ivabradine may be an ideal medication for treating POTS patients. This report provides the results of an investigation in which we studied ivabradine's effect on the hemodynamics and sympathovagal balance in POTS patients.

METHODS: An open-label trial, without a placebo control, was performed in eight patients with POTS of two years' standing. Characterization of symptoms, hemodynamics, autonomic function tests, and HR and blood pressure (BP) variability were determined while patients were in a supine position and during a 20-minute head-up tilt before and after a single oral dose of 7.5 mg ivabradine.

RESULTS: Ivabradine slowed the HR of POTS patients at rest by 4±1 bpm (P<0.05). During a 5-minute head-up tilt, the HR decreased from 118±4 bpm to 101±5 bpm (P<0.01). Ivabradine did not affect the BP when patients were at rest in a supine position or in head-up tilt position. Cardiovascular vagal and sympathetic tone, extrapolated from the time and frequency domains of the HR and BP variability, were also not affected by ivabradine.

CONCLUSIONS: Ivabradine is an effective drug for slowing the HR of POTS patients at rest and during tilting, without producing significant adverse effects. Moreover, ivabradine exerts its effects without influencing the sympathovagal balance.

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