Key result
Ivabradine use in patients with heart failure with reduced ejection fraction may induce QT prolongation and Torsade de pointes, especially with concurrent beta-blockers and loop diuretics.
Why the study?
Ivabradine has previously been associated with Torsade de pointes when used with QT-prolonging drugs or agents that block its metabolism.
Case Report (n=2)
Caution should be exercised when administering ivabradine to HFrEF patients with reduced repolarization reserve due to the risk of Torsade de pointes.
Ivabradine is a selective inhibitor of the sinoatrial node "funny" current, prolonging the slow diastolic depolarization. As it has the ability to block the heart rate selectively, it is more effective at a faster heart rate. It is recommended for the treatment of heart failure reduced ejection fraction in the presence of beta-blocker therapy for the further reduction of the heart rate. However, previous reports have shown the association of Torsade de pointes (TdP) with concurrent use of ivabradine and drugs resulting in QT prolongation or blockage of the metabolic breakdown of ivabradine. In this article, we report two cases of patients with heart failure reduced ejection fraction who developed TdP after ivabradine use. Our report highlights the need to exercise caution with the administration of ivabradine in the presence of a reduced repolarization reserve, such as QT prolongation or metabolic insufficiency.
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Jang et al. (2020) conducted a case report in Heart failure with reduced ejection fraction (n=2). Ivabradine was evaluated on Development of Torsade de pointes. Ivabradine use in patients with heart failure with reduced ejection fraction may induce QT prolongation and Torsade de pointes, especially with concurrent beta-blockers and loop diuretics.
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