• Heart Rhythm · Sep 2010

    Comparative Study

    Efficacy of ivabradine administration in patients affected by inappropriate sinus tachycardia.

    • Leonardo Calò, Marco Rebecchi, Antonella Sette, Annamaria Martino, Ermenegildo de Ruvo, Luigi Sciarra, Lucia De Luca, Lorenzo Maria Zuccaro, Giuseppe Giunta, Antonio Ciccaglioni, Ernesto Lioy, and Francesco Fedele.
    • Division of Cardiology, Policlinico Casilino, ASL RMB, Rome, Italy. leonardo.calo@tin.it
    • Heart Rhythm. 2010 Sep 1; 7 (9): 1318-23.

    BackgroundInappropriate sinus tachycardia (IST) is characterized by an elevated heart rate (HR) at rest and an exaggerated HR response to physical activity or emotional stress. Beta-blockers and calcium channel blockers are the first-line therapy but sometimes are poorly tolerated due to side effects.ObjectiveThe purpose of this study was to evaluate the efficacy and safety of ivabradine, a selective inhibitor of the I(f) current of the sinoatrial node, in patients affected by IST.MethodsEighteen consecutive symptomatic patients (2 men and 16 women; mean age 45 +/- 15 years) affected by IST were enrolled in the study. Every patient underwent resting ECG, 24-hour Holter ECG, and exercise ECG at baseline and at 3-month and 6-month follow-up.ResultsSixteen patients (14 women; mean age 41 +/- 14 years) completed the study. Holter ECG assessment showed a significant reduction of medium HR (P <.001) and maximal HR (P <.001, basal vs 3-6 months; P = .02, 3 vs 6 months). Minimal HR slightly decreased at 3 months and then stabilized (P = .49, 3 vs 6 months) despite an increased drug dose. Stress test showed a significant decrease at rest (P <.001) and maximal HR (P <.05), suggesting an increased tolerance to physical stress, which was confirmed by a progressive increase of maximal load reached (>100 W) during stress test at 3 months (75%) and 6 months (85%). One patient was excluded because of phosphenes despite dose lowering, and another patient did not complete the protocol.ConclusionIvabradine could represent an effective and safe alternative to calcium channel blockers and beta-blockers for treatment of IST.Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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