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Ivabradin

Selektive Herzfrequenzsenkung als neue Therapieoption

Ivabradine

Selective reduction of heart rate as a new therapeutic option

  • Klinische Pharmakologie
  • Published:
Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

Die Herzfrequenz in Ruhe steht in engem Zusammenhang mit dem allgemeinen und speziell dem kardiovaskulären Mortalitätsrisiko. Eine Reduktion der Mortalität durch kardiovaskulär wirksame Substanzen scheint zumindest teilweise in ihren herzfrequenzsenkenden Eigenschaften begründet zu sein. Sowohl die Pathophysiologie der Angina Pectoris bei koronarer Herzerkrankung als auch das Auftreten einer Herzinsuffizienz bei eingeschränkter linksventrikulärer Pumpfunktion sind eng mit der Ruheherzfrequenz verknüpft. Eine isolierte Herzfrequenzreduktion erscheint daher als interessanter neuer Therapieansatz und ist erstmals durch den selektiven If-Kanalblocker Ivabradin möglich. Ivabradin hemmt die spontane Depolarisation am Sinusknoten und führt so zu einer Reduktion der Herzfrequenz ohne andere kardiale Parameter oder das intrazelluläre cAMP zu verändern und ohne direkte negativ inotrope Wirkung. Erste klinische Studien erlauben einen Einsatz von Ivabradin als Reservemedikament für Patienten mit stabiler Angina Pectoris, die Unverträglichkeit oder Kontraindikationen für β-Blocker aufweisen. Auf Basis ausstehender Studien könnte die Anwendung der Substanz auch auf andere kardiovaskuläre Erkrankungen, wie z. B. die Herzinsuffizienz oder Herzrhythmusstörungen, ausgedehnt werden.

Abstract

The heart rate at rest is closely associated with total and, in particular, cardiovascular mortality. The reduction in mortality due to treatment with cardiovascular drugs seems to be partly linked with their ability to reduce the heart rate. Both the pathophysiology of angina pectoris in coronary heart disease as well as the development of cardiac insufficiency with reduced left ventricular function are closely associated with resting pulse rate. Therefore, a selective reduction in heart rate is viewed as an interesting therapeutic principle. Such a reduction can be achieved with the new, specific If-channel blocker ivabradine. Ivabradine inhibits the spontaneous depolarisation in the sinus node and thereby reduces heart rate. Other cardiac parameters such as intracellular cAMP or the inotropic state are not influenced. Recent clinical studies allow the application of ivabradine as an alternative agent in patients with stable angina pectoris who do not tolerate beta-blockade. Pending ongoing studies, ivabradine might also be useful for other cardiovascular diseases such as heart failure or rhythm disorders.

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Authors and Affiliations

  1. Medizinische Klinik II, Klinikum Weiden, Lehrkrankenhaus der Universität Regensburg, Söllnerstraße 16, 92637, Weiden i.d. OPf., Deutschland

    R.H.G. Schwinger

  2. Klinik III für Innere Medizin, Universität zu Köln, Köln, Deutschland

    C. Zobel

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  1. R.H.G. Schwinger
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  2. C. Zobel
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Correspondence to R.H.G. Schwinger.

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Schwinger, R., Zobel, C. Ivabradin. Clin Res Cardiol Suppl 2, 137–143 (2007). https://doi.org/10.1007/s11789-007-0051-3

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  • DOI: https://doi.org/10.1007/s11789-007-0051-3

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