Related Experiment Video
Updated: Feb 23, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Ivabradine in Children With Dilated Cardiomyopathy and Symptomatic Chronic Heart Failure
Damien Bonnet1, Felix Berger2, Eero Jokinen3
1M3C-Necker, Hôpital Necker Enfants Malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Insights
Ivabradine effectively reduced heart rate in children with heart failure (HF) and dilated cardiomyopathy. This study highlights ivabradine
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Cardiovascular Research
Background:
- Heart rate reduction is a therapeutic target in adult heart failure (HF).
- Ivabradine is effective in adults but not evaluated in children.
- Pediatric HF treatment often relies on adult guidelines.
Purpose of the Study:
- To explore the dose-response relationship of ivabradine in children with dilated cardiomyopathy and symptomatic chronic HF.
- To assess the primary endpoint of a ≥20% heart rate reduction without inducing bradycardia or symptoms.
- To evaluate ivabradine's efficacy and safety in pediatric patients.
Main Methods:
- A randomized, double-blind, placebo-controlled, phase II/III study with 116 children.
- Participants received stable HF therapy with either ivabradine or placebo for 12 months.
- Dose titration aimed to achieve the primary endpoint; left ventricular function, clinical status, N-terminal pro-B-type natriuretic peptide, and quality of life were assessed.
Main Results:
- 70% of children on ivabradine reached the primary endpoint versus 12% on placebo (OR: 17.24; p < 0.0001).
- Ivabradine showed a greater increase in left ventricular ejection fraction (13.5% vs. 6.9%; p=0.024).
- Improvements in functional class and quality of life showed favorable trends with ivabradine.
Conclusions:
- Ivabradine safely reduced resting heart rate in children with chronic HF and dilated cardiomyopathy.
- Dose titration is crucial due to variable heart rate effects.
- Ivabradine improved left ventricular ejection fraction, with positive trends in clinical status and quality of life.
Background:
Heart rate reduction as a therapeutic target has been investigated in adults with heart failure (HF). Ivabradine has shown promising efficacy, but has not been evaluated in children. Currently, treatment recommendations for chronic pediatric HF are based mainly on chronic HF guidelines for adults.
Objectives:
The authors explored the dose-response relationship of ivabradine in children with dilated cardiomyopathy and symptomatic chronic HF. The primary endpoint was ≥20% reduction in heart rate from baseline without inducing bradycardia or symptoms.
Methods:
This was a randomized, double-blind, placebo-controlled, phase II/III study with 12 months of follow-up. Children (n = 116) receiving stable HF therapy were randomized to either ivabradine or placebo. After an initial titration period, the dose was adjusted to attain the primary endpoint. Left ventricular function (echocardiography), clinical status (New York Heart Association functional class or Ross class), N-terminal pro-B-type natriuretic peptide, and quality of life (QOL) were assessed.
Results:
The primary endpoint was reached by 51 of 73 children taking ivabradine (70%) versus 5 of 41 taking placebo (12%) at varying doses (odds ratio: 17.24; p < 0.0001). Between baseline and 12 months, there was a greater increase in left ventricular ejection fraction in patients taking ivabradine than placebo (13.5% vs. 6.9%; p = 0.024). New York Heart Association functional class or Ross class improved more with ivabradine at 12 months than placebo (38% vs. 25%; p = 0.24). There was a trend toward improvement in QOL for ivabradine versus placebo (p = 0.053). N-terminal pro-B-type natriuretic peptide levels decreased similarly in both groups. Adverse events were reported at similar frequencies for ivabradine and placebo.
Conclusions:
Ivabradine safely reduced the resting heart rate of children with chronic HF and dilated cardiomyopathy. Ivabradine's effect on heart rate was variable, highlighting the importance of dose titration. Ivabradine treatment improved left ventricular ejection fraction, and clinical status and QOL showed favorable trends. (Determination of the efficacious and safe dose of ivabradine in paediatric patients with dilated cardiomyopathy and symptomatic chronic heart failure from ages 6 months to 18 years; ISRCTN60567801).
More Related Videos
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
14:24Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model
Published on: January 21, 2018
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inotropic Agents
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
01:30Heart Failure V: Medical Management
01:22Heart Failure VI: Adjunct Therapies