Inotropic effects of ivabradine in the mammalian heart

Ivabradine represents a novel heart-rate-lowering agent that acts on the sino-atrial node supposedly by selectively inhibiting the 'funny' current (I(f) current). In clinical studies, it was reported that ivabradine effectively reduced resting heart rate and was well tolerated. The aim of this study was to evaluate potential effects of ivabradine on cardiac contractility. Contractile effects of ivabradine were studied in isolated electrically driven atrial preparations from patients undergoing cardiac bypass surgery and for comparison in isolated spontaneously beating right atria and electrically driven left atria from mice. In human trabeculae, a concentration-dependent negative inotropic effect was noted in 7 from 10 patients. However, in 3 patients from 10, a pronounced positive inotropic effect of ivabradine was noted. As expected, in spontaneously beating mouse right atria ivabradine exerted a concentration-dependent negative chronotropic effect. Unexpectedly, contractile effects in mouse and man seem to disagree. In mouse left atria, ivabradine and cilobradine, another hyperpolarization-activated cyclic-nucleotide-gated blocker, always exerted a pronounced positive inotropic effect. These positive inotropic effects were converted to negative inotropic effects in the additional presence of the L-type Ca²+ channel blocker verapamil. The present study demonstrates that ivabradine at high concentrations can affect the force of contraction in atrial preparations from the human heart.