From the Guidelines
Ivabradine is a recommended treatment for patients with symptomatic inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS), as stated in the 2020 ESC guidelines for the management of patients with supraventricular tachycardia 1. The benefits of ivabradine in patients with SVT have been demonstrated in several trials. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia, ivabradine is reasonable for ongoing management in patients with symptomatic IST, with a dosage of 2.5 to 7.5 mg twice daily significantly reducing daytime heart rate and improving exercise tolerance and symptoms 1. Some key points to consider when using ivabradine for SVT include:
- Ivabradine can cause phosphenes, an enhanced brightness in a portion of the visual field, which is usually transient and reported in 3% of patients taking the drug 1.
- The combination of beta blockers and ivabradine may be considered for ongoing management in patients with IST, but patients should be monitored closely for the possibility of excess bradycardia 1.
- Ivabradine works by selectively inhibiting the If current in the sinoatrial node, thereby slowing heart rate without affecting blood pressure or cardiac contractility, making it particularly useful for SVT patients who cannot tolerate beta-blockers or calcium channel blockers.
- Treatment duration with ivabradine typically ranges from 6 weeks to 6 months, with benefits often observed within the first 2 weeks of therapy. It is essential to note that while ivabradine has shown benefits in patients with SVT, the evidence is based on trials with specific patient populations and may not be generalizable to all patients with SVT. Therefore, treatment decisions should be made on a case-by-case basis, taking into account individual patient characteristics and medical history.
From the Research
Trials Showing Benefits of Ivabradine in Patients with SVT
- The study 2 discusses the off-label utilization of ivabradine in pediatric patients with SVT and highlights its efficacy in treating treatment-resistant (refractory) SVT.
- In the study 3, ivabradine demonstrated favorable efficacy and safety results in patients under 6 months of age with SVT, with a statistically significant reduction in heart rate.
- Although the studies 4, 5, and 6 primarily focus on the treatment of inappropriate sinus tachycardia, they also provide insight into the effectiveness of ivabradine in reducing heart rate, which can be beneficial for patients with SVT.
Key Findings
- Ivabradine appears to be a safe and well-tolerated medication that can induce adequate suppression of SVT, complete reversal to sinus rhythm, and effective enhancement of left ventricular function 2.
- The use of ivabradine in pediatric patients with refractory SVT shows promissory results, with successful reversal to sinus rhythm achieved in two of the three patients (66%) 2.
- Ivabradine has been shown to be effective in reducing heart rate in patients with SVT, with a statistically significant reduction in heart rate observed in both the HF and SVT groups 3.