Use of Ivabradine in Postural Orthostatic Tachycardia Syndrome

Postural orthostatic tachycardia syndrome (POTS) is characterized by inappropriate increase in heart rate on assuming upright position from a supine position without a necessary drop in blood pressure. Etiology of this condition is complex and multifactorial. Autonomic dysfunction,[1] hypovolemia,[2] hyper responsiveness of beta adrenergic receptors[3] with associated elevations of plasma norepinephrine levels have been implicated as underlying pathophysiologic mechanisms. Beta blockers have previously been used to treat this condition. Ivabradine which selectively inhibits If ion current in the sino atrial node, has been reported to be useful in patients with POTS.[4,5] We present one further such case of POTS successfully treated by Ivabradine.