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Ivabradine: potential clinical applications in critically ill patients

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Abstract

It has been extensively demonstrated that an elevated heart rate is a modifiable, independent risk factor for cardiovascular events. A high heart rate increases myocardial oxygen consumption and reduces diastolic perfusion time. It can also increase ventricular diastolic pressures and induce ventricular arrhythmias. Critical care patients are prone to develop a stress induced cardiac impairment and consequently an increase in sympathetic tone. This in turn increases heart rate. In this setting, however, heart rate lowering might be difficult because the effects of inotropic drugs could be hindered by heart rate reducing drugs like beta-blockers. Ivabradine is a new selective antagonist of funny channels. It lowers heart rate, reducing the diastolic depolarization slope. Moreover, ivabradine is not active on sympathetic pathways, thus avoiding any interference with inotropic amines. We reviewed the literature available regarding heart rate control in critical care patients, focusing our interest on the use of ivabradine to assess the potential benefits of the drug in this particular setting.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, Azienda USL di Ravenna, Viale Randi 5, 48121, Ravenna, Italy

    Vincenzo De Santis

  2. Department of Anesthesiology and Intensive Care, Azienda USL di Cuneo, Cuneo, Italy

    Domenico Vitale

  3. Department of Anesthesiology and Intensive Care, “Sapienza” University of Rome, Rome, Italy

    Anna Santoro, Aurora Magliocca, Andrea Giuseppe Porto & Luigi Tritapepe

  4. Department of Anesthesiology and Intensive Care, Azienda Ospedaliera S. Camillo, Forlanini, Rome, Italy

    Cecilia Nencini

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  1. Vincenzo De Santis
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Correspondence to Vincenzo De Santis.

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De Santis, V., Vitale, D., Santoro, A. et al. Ivabradine: potential clinical applications in critically ill patients. Clin Res Cardiol 102, 171–178 (2013). https://doi.org/10.1007/s00392-012-0516-3

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