Related Experiment Videos

Ivabradine: recent and potential applications in clinical practice

Graziano Riccioni1

  • 1Intensive Cardiology Care Unit, San Camillo De Lellis Hospital, Manfredonia (FG), Italia. griccioni@hotmail.com

Expert Opinion on Pharmacotherapy
|January 25, 2011
PubMed

Insights

High heart rate predicts mortality. Ivabradine, a heart-rate-lowering drug, shows comparable anti-ischemic and antianginal efficacy to beta-blockers and improves cardiac outcomes in specific patient groups.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart rate is a significant predictor of cardiovascular and all-cause mortality across diverse populations.
  • High heart rate independently contributes to myocardial ischemia, atherosclerosis, ventricular arrhythmias, and impaired left ventricular function.

Purpose of the Study:

  • To review recent findings on ivabradine, a selective I(f) current inhibitor.
  • To explore potential future applications of ivabradine in cardiovascular medicine.

Main Methods:

  • Review of published data and recent results concerning ivabradine.
  • Exploration of the mechanism of action of ivabradine (selective inhibition of the I(f) current).

Main Results:

  • Ivabradine demonstrates antianginal and anti-ischemic properties comparable to established anti-anginal agents.
  • Ivabradine has shown efficacy equivalent to beta-blockers and calcium channel antagonists in treating chronic stable angina.
  • Recent studies indicate ivabradine improves cardiac outcomes in patients with stable coronary artery disease and left ventricular systolic dysfunction with heart rates ≥ 70 bpm.

Conclusions:

  • Heart rate measurement is crucial in assessing patients with coronary artery disease and chronic heart failure, akin to other risk factors.
  • Elevated heart rate has direct adverse effects on myocardial ischemia, atherosclerosis progression, ventricular arrhythmias, and left ventricular function.
  • Ivabradine offers a valuable therapeutic option for managing heart rate and improving cardiovascular outcomes in selected patient populations.
Abstract

Related Concept Videos

Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers01:24

Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers

Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which indirectly block calcium...
Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers01:22

Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers

Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers01:12

Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers

Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of the heart's...
Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers01:20

Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers

Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
Therapeutic Drug Monitoring: Overview and Classification01:16

Therapeutic Drug Monitoring: Overview and Classification

Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood at designated intervals to ensure the drug concentration stays within a therapeutic range. This monitoring is crucial for optimizing individual dosage regimens, enhancing therapeutic efficacy, and minimizing drug-related toxicity. TDM is vital for drugs with narrow therapeutic windows, significant variability in pharmacokinetics, and a clear correlation between plasma levels and...
Cardiovascular Drugs: Classification based on Therapeutic Indications01:18

Cardiovascular Drugs: Classification based on Therapeutic Indications

Cardiovascular diseases, encompassing a range of conditions, can significantly affect the heart's operations and the overall circulatory system. These conditions impair the heart's ability to pump blood, leading to a deficit in oxygen supply to crucial organs. Anomalies in the heart's electrical system, known as arrhythmias, can cause heartbeats to accelerate or slow down. Usually, heart rates increase during physical activity and decrease while resting or sleeping. However, frequent irregular...