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Risk-benefit assessment of ivabradine in the treatment of chronic heart failure

Authors Urbanek I, Kaczmarek K, Cygankiewicz I, Ptaszynski P

Received 9 February 2014

Accepted for publication 10 March 2014

Published 28 April 2014 Volume 2014:6 Pages 47—54


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Irmina Urbanek, Krzysztof Kaczmarek, Iwona Cygankiewicz, Pawel Ptaszynski

Department of Electrocardiology, Chair of Cardiology and Cardiosurgery, Medical University, Lodz, Poland

Abstract: Heart rate is not only a major risk marker in heart failure but also a general risk marker. Within the last few years, it has been demonstrated that reduction of resting heart rate to <70 bpm is of significant benefit for patients with heart failure, especially those with impaired left ventricular systolic function. Ivabradine is the first innovative drug synthesized to reduce heart rate. It selectively and specifically inhibits the pacemaker If ionic current, which reduces cardiac pacemaker activity. Therefore, the main effect of ivabradine therapy is a substantial lowering of heart rate. Ivabradine does not influence intracardiac conduction, contractility, or ventricular repolarization. According to the European Society of Cardiology guidelines, ivabradine should be considered in symptomatic patients (New York Heart Association functional class II–IV) with sinus rhythm, left ventricular ejection fraction ≤35%, and heart rate ≥70 bpm despite optimal treatment with a beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and a mineralocorticoid receptor antagonist. As shown in numerous clinical studies, ivabradine improves clinical outcomes and quality of life and reduces the risk of death from heart failure or cardiovascular causes. Treatment with ivabradine is very well tolerated and safe, even at maximal recommended doses.

Keywords: ivabradine, heart failure, heart rate

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