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Atrial Fibrillation

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Other hemodynamic effects have also been reported with usage of ivabradine. In a study by Kurtoglu et al, ivabradine was seen to improve heart rate variability in non-ischemic patients with heart failure. (26). De Luca et al showed that addition of ivabradine to optimal medical therapy in patients with stable heart failure with preserved ejection fraction with New York Heart Association (NYHA) class II, left ventricular ejection fraction (LVEF) > 50% and heart rate > 70 bpm, significantly improved physical performance by increasing exercise capacity (27). Another study in patients with stable ischemic heart failure, NYHA functional class II and LVEF ≤ 40%, confirmed these findings and additionally showed an improved gas exchange (with improvement …show more content…

Atrial fibrillation is an important side effect with ivabradine with a recent meta-analysis showing a 15% increase in its incidence with the use of Ivabradine (37). Another combined analysis of SHIFT trial and BEAUTIFUL study reported an increase in atrial fibrillation incidence in this population with a number needed to harm of 58 (38). A proposed mechanism of Ivabradine leading to atrial fibrillation is genetic polymorphisms in HCN4 receptors causing an enhanced effect of ivabradine (39). As mentioned above, HCN4 receptors are found not only in the SA node but also AV node and individuals with genetic polymorphisms of HCN4 can have significant inhibition of the two primary pacemakers tissues of the heart. This provides substrate for atrial tissue to discharge and convert rhythm into atrial fibrillation.
Phosphenes is another side effect observed with ivabradine. It refers to perceiving transient enhanced brightness limited to a small area of the visual field. The underlying mechanism of this side effect is an extension of the hyperpolarization current inhibition by ivabradine. The photoreceptors in retina utilize the hyperpolarization current to send neurological signals o flight perception to the brain. However, this can be dysregulated in susceptible individuals with ivabradine. This side effect resolves shortly after …show more content…

Another study by Dedkov et al demonstrated that mice with STEMI when treated with Ivabradine had improved ejection fraction, coronary reserve and the amount of interstitial and periarteriolar collagen indicating that this agent might be useful in preventing remodeling of heart (46). A pilot study of 124 patients investigating the role of Ivabradine in successfully reperfused STEMI patients demonstrated promising results with a smaller increase in LV end-diastolic volume index (p=0.04), and significant improvement in LV ejection fraction compared with the control group (p=0.04)

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