Ivabradine may serve as a useful alternative for therapeutic heart rate management in patients with coronary artery disease and heart failure who cannot tolerate beta-blockers.
Ivabradine, an I(f) inhibitor, acts primarily on the sinoatrial node and is used to reduce the heart rate with minimal effect on myocardial contractility, blood pressure, and intracardiac conduction. Heart rate reduction is an important aspect of care in patients with chronic stable angina and heart failure. Many patients with coronary artery disease have coexisting asthma or chronic obstructive airway disease, and most of them are unable to tolerate beta blockers. Ivabradine may thus be a useful medicine in therapeutic heart rate management especially in patients who are intolerant of beta-blockers.
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Liang et al. (2009) studied this question.
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