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Ivabradine in children with postural orthostatic tachycardia syndrome: a retrospective study
Arooge Towheed1, Zeid Nesheiwat2, Muhammad A Mangi1
1Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA.
Insights
Ivabradine effectively treated postural orthostatic tachycardia syndrome in children, with 67% experiencing symptom improvement. This heart rate-lowering medication significantly reduced syncope and lightheadedness in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Pharmacology
Background:
- Postural orthostatic tachycardia syndrome (POTS) affects children, causing debilitating symptoms.
- Ivabradine targets the sinus node's funny current to reduce heart rate.
Purpose of the Study:
- Assess ivabradine's efficacy in pediatric patients with POTS.
- Evaluate changes in symptom severity, frequency, heart rate, and blood pressure.
Main Methods:
- Retrospective cohort study of 27 pediatric POTS patients treated with ivabradine (Jan 2015-Feb 2019).
- Chart review analyzing symptom changes, heart rate, and blood pressure pre- and post-treatment.
Main Results:
- 67% of patients (18/27) showed symptom improvement.
- Significant reductions in syncope/presyncope (90%), lightheadedness (85%), and fatigue (81%).
- Heart rate decreased significantly during sitting and standing; blood pressure remained stable. Adverse events included visual disturbances and bradycardia.
Conclusions:
- Ivabradine is an effective treatment for pediatric POTS, improving key symptoms in a majority of patients.
- The medication demonstrates a favorable safety profile in this pediatric cohort.
Background:
Ivabradine is a unique medication that reduces the intrinsic heart rate by specifically blocking the inward funny current that controls the pacemaker activity of the sinus node. We conducted a retrospective cohort study to assess the efficacy of ivabradine in children suffering from postural orthostatic tachycardia syndrome.
Methods:
A chart review was conducted of patients less than 18 years of age who were diagnosed with postural orthostatic tachycardia syndrome who had received ivabradine as treatment from January 2015 to February 2019 at our institution. Twenty-seven patients (25 females, 92.5%) were identified for the study. The outcomes which were assessed included a change in the severity and frequency of symptoms, heart rate, and blood pressure before and after starting ivabradine.
Results:
There was an improvement in the symptoms of 18 (67%) out of 27 patients. The most notable symptom affected was syncope/presyncope with a reduction in 90%, followed by lightheadedness (85%) and fatigue (81%). The vital signs of the patients showed an overall significant lowering of the heart rate during sitting (89.7 ± 17.9 versus 73.2 ± 12.1; p-value <0.05) and standing (100.5 ± 18.1 versus 80.9 ± 10.1; p-value <0.05) without a significant change in the blood pressure. Two patients had visual disturbances (luminous phenomena). Severe bradycardia and excessive flushing were seen in two patients, respectively. Another one patient reported joint pain and fatigue.
Conclusion:
This study indicates that 67% of children treated with ivabradine report an improvement in symptoms.
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