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DOI: 10.1055/s-0034-1367315
Effects of ivabradine in patients with persistent sinus tachycardia early after heart transplantation
Objective: Inappropiate sinus tachycardia after cardiac surgery is often treated with b-blockers. After cardiac transplantation this treatment may significantly impair cardiac function, particularly regarding right ventricle. Recent studies have shown a favorable response to ivabradine, a new I (f) channel antagonist. We wanted to evaluate effects and side-effects of ivabradine in the early period after heart transplantation (htx).
Methods: Between 10/2010 and 09/2013 33 patients underwent htx in our department. Of those, ivabradine was administered in 16 patients immediately after htx (starting on POD 5-27), in addition to ß-blockers in 4 patients. Of the other 17 patients, 8 received ß-blockers due to sinus tachycardia. Ivabradine treatment was initiated in cases of a basal heart rate > 100 bpm for > 24 hours and after excluding all other causes of this sinus tachycardia.
Results: There were no substantial adverse effects in all patients with ivabradine. Mean heart rate was reduced from 112.4 ± 15.3 bpm at baseline to 90.3 ± 11.6 bpm before hospital discharge (p < 0.05). Echocardiographic evaluation confirmed an improvement of cardiac function, correlating to substantial clinical advances. We did not detect relevant interactions with immunosuppressants, except from a distinct increase of mycophenolate mofetil blood levels.
Conclusions: With our results we could demonstrate that patients with inappropriate sinus tachycardia after htx can be successfully treated with ivabradine. Reducing the resting heart rate, it did not negatively influence cardiac contractility. Interactions with immunosuppressive medication or other adverse effects could not be detected.