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Ivabradine in Cardiovascular Disease Management Revisited: a Review

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Abstract

Ivabradine is a unique agent that is distinct from beta-blockers and calcium channel blockers as it reduces heart rate without affecting myocardial contractility or vascular tone. Ivabradine is a use-dependent inhibitor targeting the sinoatrial node. It is approved for use in the United States as an adjunct therapy for heart rate reduction in patients with heart failure with reduced ejection fraction. In this scenario, ivabradine has demonstrated improved clinical outcomes due to reduction in heart failure readmissions. However, there has been conflicting evidence from prospective studies and randomized controlled trials for its use in stable ischemic heart disease regarding efficacy in symptom reduction and mortality benefit. Ivabradine may also play a role in the treatment of patients with inappropriate sinus tachycardia, who often cannot tolerate beta-blockers and/or calcium channel blockers. In this review, we highlight the evidence for the nuances of using ivabradine in heart failure, stable ischemic heart disease, and inappropriate sinus tachycardia to raise awareness for its vital role in the treatment of select populations.

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Fig. 1

Data Availability

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Abbreviations

ACh:

Acetylcholine

ACC:

American College of Cardiology

AHA:

American Heart Association

bpm:

Beats per minute

BNP:

Brain natriuretic peptide

CAD:

Coronary artery disease

cAMP:

Cyclic adenosine monophosphate

CCS:

Canadian Cardiovascular Society

CI:

Confidence interval

CV:

Cardiovascular

CVD:

Cardiovascular disease

CYP:

Cytochrome P

EF:

Ejection fraction

EHRA:

European Heart Rhythm Association

EMA:

European Medicines Agency

ESC:

European Society of Cardiology

FDA:

Food and Drug Administration

HCN:

Hyperpolarization-activated cyclic-nucleotide

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

HR:

Hazard ratio

If :

Funny current

IST:

Inappropriate sinus tachycardia

KCCQ:

Kansas City Cardiomyopathy Questionnaire

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

NYHA:

New York Heart Association

QOL:

Quality of life

SA:

Sinoatrial

SBP:

Systolic blood pressure

SIHD:

Stable ischemic heart disease

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  1. Christopher Chen and Gurleen Kaur contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA

    Christopher Chen

  2. Albany Medical College, Albany, NY, USA

    Gurleen Kaur

  3. Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Puja K. Mehta

  4. Division of Cardiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy

    Doralisa Morrone

  5. Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada

    Lucas C. Godoy

  6. Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Lucas C. Godoy

  7. Division of Cardiology, New York University Grossman School of Medicine, New York, NY, USA

    Sripal Bangalore

  8. Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA

    Mandeep S. Sidhu

Authors
  1. Christopher Chen
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  2. Gurleen Kaur
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  3. Puja K. Mehta
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  4. Doralisa Morrone
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  5. Lucas C. Godoy
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  6. Sripal Bangalore
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  7. Mandeep S. Sidhu
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Contributions

Conception of the idea for the review: Dr. Chen, Dr. Mehta, and Dr. Sidhu.

Performed the literature search and drafted the review: Dr. Chen and Ms. Kaur.

Critical revision of drafts: Dr. Mehta, Dr. Morrone, Dr. Godoy, Dr. Bangalore, and Dr. Sidhu.

Corresponding author

Correspondence to Mandeep S. Sidhu.

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Chen, C., Kaur, G., Mehta, P.K. et al. Ivabradine in Cardiovascular Disease Management Revisited: a Review. Cardiovasc Drugs Ther 35, 1045–1056 (2021). https://doi.org/10.1007/s10557-020-07124-4

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