Ivabradine – ABC CARDIOL

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Original Article

Use of Ivabradine in the Treatment of Patients with Postural Orthostatic Tachycardia Syndrome (POTS): A Systematic Review

Ana Paula Giannella de Melo et al. Miguel Antônio Moretti Antonio Carlos Palandri Chagas

Abstract

Background

Postural Orthostatic Tachycardia Syndrome (POTS) is an autonomic dysfunction characterized by symptoms of orthostatic intolerance, associated with an increase in heart rate within 10 minutes of assuming an upright position or head-up tilt, in the absence of hypotension. There are three phenotypes of POTS – neuropathic, hypovolemic, and hyperadrenergic – and all result in tachycardia and altered cerebral perfusion. Pharmacological therapy is indicated in certain cases; however, no specific medication has yet been approved for this condition. Some studies have shown that ivabradine may be beneficial, as it reduces heart rate without affecting blood pressure.

Objectives

To evaluate the efficacy and safety of ivabradine in the treatment of POTS.

Method

Systematic review using the descriptors “Ivabradine” and “Postural Orthostatic Tachycardia Syndrome” in the PubMed, Scielo, LILACS, and Google Scholar databases. Articles were grouped and assessed using the PICO strategy.

Results

A total of 52 articles were identified, of which seven were included in the review – three prospective and four retrospective studies. In total, 203 patients were evaluated, the majority of whom were female. All studies reported a significant reduction in heart rate and improvement in symptoms of orthostatic intolerance, with most patients not reporting adverse effects, regardless of their POTS phenotype.

Conclusion

Ivabradine proved to be effective and safe in the treatment of patients with POTS.

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Case Report

Post-COVID Tachycardia Syndrome: Could It Be Myocarditis? A Case Report of a Patient Treated with Ivabradine

Davyson Gerhardt de Souza et al. Vanessa do Amaral Tinoco Ligia Cordeiro Matos Faial Humberto Villacorta

Abstract

This report illustrates a case of acute myocarditis in a patient who was recently hospitalized for COVID-19. Myocarditis was suspected based on the presence of tachycardia, the only abnormality present on physical examination, as well as high levels of B-type natriuretic peptide. The diagnosis was confirmed with cardiac magnetic resonance image, which showed the presence of late enhancement, predominantly subepicardial, in the inferolateral and inferior walls of the left ventricle. The patient did not meet any of the criteria for endomyocardial biopsy (progressive heart failure, severe cardiac dysfunction, ventricular arrhythmias, atrioventricular blocks). Therefore, the treatment was focused on heart rate control. Beta-blocker is the first option for rate control, but the patient had a contraindication. Thus, ivabradine, a selective heart rate reducer was used. This drug has been poorly studied in the context of post-COVID-19 syndromes, and the present case suggests a benefit for heart rate control in patients with post-COVID-19 tachycardia syndrome.

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Use of Ivabradine in the Treatment of Patients with Postural Orthostatic Tachycardia Syndrome (POTS): A Systematic Review

Abstract

Background

Objectives

Method

Results

Conclusion

Post-COVID Tachycardia Syndrome: Could It Be Myocarditis? A Case Report of a Patient Treated with Ivabradine

Abstract

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)