Key result
Ivabradine safely lowers heart rate and improves palpitations and syncope in POTS as second-line therapy.
Why the study?
There is no FDA-approved drug or uniform management strategy for postural orthostatic tachycardia syndrome, prompting a review of studies and case reports on ivabradine.
Does ivabradine improve symptoms in patients with postural orthostatic tachycardia syndrome?
Does ivabradine improve symptoms in patients with postural orthostatic tachycardia syndrome?
Ivabradine appears to be a safe and effective alternative to beta-blockers for managing symptoms of postural orthostatic tachycardia syndrome, warranting further investigation in randomized controlled trials.
May support ivabradine as second-line in POTS; leaves open confirmation in randomized trials.
Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by symptoms such as palpitations, dyspnea, chest discomfort, and lightheadedness affecting various systems. The pathophysiology of POTS is not completely understood due to a variety of symptoms showing that the disease is multifactorial. There is no approved uniform management strategy for POTS and hence, no drug has been approved by the United States (US) Food and Drug Administration (FDA) for it. Ivabradine is an FDA-approved drug for stable symptomatic heart failure (HF) and patients with an ejection fraction (EF) of ≤35%. Previous studies have depicted improvement in symptoms of POTS with the use of ivabradine. It is a selective inhibitor of funny sodium channels (If) in the sinoatrial (SA) node cells resulting in the prolongation of the slow diastolic depolarization (phase IV) and reduction in the heart rate (HR). Although beta-adrenoceptor blockers are commonly used to lower HR in patients with POTS, they are less ideal due to numerous adverse effects. This review aims to provide a comprehensive and up-to-date picture of all the studies and case reports that utilized ivabradine for the treatment of POTS along with a precise overview of epidemiology, pathophysiology, and types of POTS. To conclude, we recommend further research on the effectiveness of ivabradine in patients who experience symptoms of POTS. Other than stable chronic angina pectoris, its application in this setting has been proven to be effective and safe. Further evaluation by means of randomized control trials is required to encourage use of this HR-lowering agent in common disorders other than HF and stable angina, i.e. POTS.
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Tahir et al. (2020) conducted a review in Postural Orthostatic Tachycardia Syndrome (POTS). Ivabradine was evaluated. Ivabradine effectively reduces heart rate and improves symptoms such as palpitations and syncope in patients with postural orthostatic tachycardia syndrome, demonstrating safety as a second-line therapy.