[Heart rate reduction as a therapeutic strategy: novel options]

Elevated heart rate is associated with increased cardiovascular mortality. Heart rate reduction optimises myocardial oxygen consumption and decreases angina pectoris symptoms. Thus, heart rate control is an important therapeutic strategy in coronary artery disease and, for example, chronic heart failure. The pacemaker current I(f) plays a central role in determining spontaneous activity of the sinus node. Ivabradine, a selective inhibitor of the I(f) channel, reduces heart rate without any effect on cardiac contractility and without lowering blood pressure. While beta-blockers remain the first choice for heart rate reduction, in cases of adverse effects ivabradine may be used to treat stable angina pectoris. Studies evaluating possible further uses, for example in heart failure or after acute myocardial infarction, are still warranted.