Cor Vasa 2004, 45(6):291-295
The importance of slowing heart rate. Potential therapeutic use of ivabradin
- Klinika kardiologie, Institut klinické a experimentální medicíny, subkatedra kardiologie IPVZ, Praha, Česká republika
A high heart rate (HR) indicates the risk of adrenergic hyperactivity, thus contributing to the development of left ventricular hypertrophy, insulin resistance; it is associated with a lower fibrillation threshold, lower exercise tolerance, and carries an increased risk for coronary thrombosis.
One should thus reasonably assume that therapeutic HR slowing could have a beneficial effect. This premise seems to be fully justified in modulating angina where HR is one of the main determinants of myocardial oxygen consumption thereby affecting total cardiac work. HR slowing results in an increase in ischemic threshold and improved myocardial exercise tolerance.
Ivabradin is a member of a new class of drugs selectively decreasing HR, which acts specifically in the sinoatrial node. Ivabradin specifically and selectively inhibits If current (primary pacemaker sinoatrial node current) thus resulting in a specific decrease in HR.
The antiischemic efficacy of ivabradin during exercise was compared both with the beta-blocker atenolol and with the calcium-channel blocker amlodipine. No difference was seen between the antiischemic efficacy of ivabradin versus that of atenonol or amlodipine.
As HR slowing exerts a retarding effect on coronary atherosclerosis, it is quite clear that the effect of ivabradin-based HR slowing on preventing atherosclerosis progression is being investigated using intravascular Doppler.
Keywords: Ivabradin; Heart rate slowing; Treatment of stable angina
Published: June 1, 2004 Show citation