Effects of Ivabradine on Patients with Depressed Left Ventricular Function after Cardiac Resynchronization Therapy
Hung-Yu Chang1,2, Hsin-Ti Huang3, Chi-Yen Wang4
1Heart Center, Cheng Hsin General Hospital.
Insights
Ivabradine effectively reduced heart rate and improved physical activity in heart failure patients with cardiac resynchronization therapy. This treatment was safe and did not worsen atrial fibrillation or pacing in CRT recipients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF).
- The combined effect of ivabradine and CRT in HF patients is understudied.
- This study investigates ivabradine's benefits in patients with left ventricular dysfunction post-CRT.
Purpose of the Study:
- To evaluate the clinical benefits of adding ivabradine to CRT in heart failure patients.
- To assess the impact of ivabradine on heart rate and physical activity in this population.
Main Methods:
- A cohort of 231 heart failure patients receiving CRT was analyzed.
- 123 patients with LVEF < 40% and resting HR ≥ 75 bpm post-CRT were selected.
- 45 patients received ivabradine (Group 1), while 78 did not (Group 2).
Main Results:
- Ivabradine significantly reduced mean heart rate (82.2 to 76.3 bpm) and improved LVEF (29.9% to 38.8%).
- Patients on ivabradine showed a significant increase in daily physical activity.
- No significant differences in atrial fibrillation burden or biventricular pacing were observed.
Conclusions:
- Ivabradine is a safe and effective addition to CRT for heart failure patients.
- It helps reduce heart rate and enhance physical activity without compromising pacing or increasing AF burden.
Background:
The potential synergistic effect of ivabradine and cardiac resynchronization therapy (CRT) in heart failure (HF) patients has rarely been studied. We aimed to evaluate the clinical benefits of ivabradine in patients with left ventricular dysfunction following CRT implantation.
Methods:
Two hundred and thirty-one patients receiving CRT were consecutively enrolled between January 2014 and December 2018 from two HF centers. A total of 123 patients had left ventricular ejection fraction (LVEF) < 40% and resting sinus heart rate (HR) ≥ 75 bpm after six months of CRT implantation. Among these patients, 45 were treated with ivabradine (Group 1), and 78 did not receive ivabradine treatment (Group 2).
Results:
Baseline characteristics and prescription rates of HF medications other than ivabradine were similar between the two groups. In Group 1, the mean HR decreased from 82.2 ± 11.4 bpm to 76.3 ± 10.5 bpm (p = 0.012), and the mean LVEF increased from 29.9 ± 6.5% to 38.8 ± 12.4% (p < 0.001). Atrial pacing percentage, biventricular pacing percentage, and burden of atrial fibrillation (AF) were not significantly different between the two groups during the study period. The patients' daily physical activity increased significantly in Group 1 compared to Group 2 (Δ daily activity 0.4 ± 0.7 hours/day vs. -0.1 ± 7.2 hours/day, p < 0.001).
Conclusions:
Ivabradine could effectively reduce HR and improve physical activity. It was safe to use and did not increase AF burden or affect biventricular pacing percentage in CRT recipients.
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