Role of ivabradine in postoperative tachyarrhythmias after congenital cardiac surgery

BACKGROUND Postoperative tachyarrhythmias are a common complication following congenital cardiac surgery. Junctional ectopic tachycardia (JET) is the most frequent arrhythmia, often linked to heightened automaticity. Ivabradine, a selective inhibitor of the funny current (HCN4), has recently gained attention for its potential role in managing automatic tachyarrhythmias. Standard antiarrhythmic therapies, such as amiodarone, are limited by significant side effects. METHODS This retrospective study was conducted at a high-volume cardiac center between January 2024 and June 2025. 55 patients developed postoperative tachyarrhythmias who were treated with ivabradine at 0.2 mg/kg/dose, either as monotherapy or in combination with other antiarrhythmic agents. Patients with postoperative ventricular tachycardia were excluded. RESULTS Among 55 patients, the most common arrhythmia was JET (n = 42), followed by ectopic atrial tachycardia (n = 5), premature atrial contractions (n = 5), and inappropriate sinus tachycardia (n = 3). Overall, 69% of patients were successfully managed with ivabradine monotherapy, while 31% required adjunctive therapy, most commonly amiodarone. Patients requiring adjunctive therapy were more difficult to achieve rhythm control and had longer ICU and hospital durations (72 hours vs 24 hours, p < 0.001). No significant hemodynamic compromise or adverse effects associated with ivabradine were observed. CONCLUSION Ivabradine monotherapy is effective for the majority of postoperative automaticity-driven tachyarrhythmias in patients undergoing congenital cardiac surgery who are hemodynamically stable. However, adjuvant therapy to ivabradine might be needed, especially in patients at risk for deteriorated condition.