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Ivabradine effects on COVID-19-associated postural orthostatic tachycardia syndrome: a single center prospective
Mahmoud Abdelnabi1, Yehia Saleh2, Ashraf Ahmed3
1Internal Medicine Department, Texas Tech University Health Science Center Lubbock, Texas, USA.
Insights
Ivabradine effectively improved symptoms in patients with COVID-19-associated Postural Orthostatic Tachycardia Syndrome (POTS). Treatment led to reduced heart rate and improved heart rate variability within seven days.
Area of Science:
- Cardiology
- Infectious Diseases
- Autonomic Neurology
Background:
- COVID-19 is linked to various cardiac arrhythmias, often due to autonomic nervous system dysfunction.
- Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by tachycardia and affects younger individuals.
- Limited data exists on ivabradine's efficacy and safety for POTS.
Purpose of the Study:
- To evaluate the safety and efficacy of ivabradine in treating COVID-19-associated POTS.
- To assess the impact of ivabradine on heart rate and heart rate variability in these patients.
Main Methods:
- A prospective observational study included 55 patients with COVID-19-associated POTS.
- Ivabradine 5 mg twice daily was administered.
- Patients were reassessed after 3 days for symptom changes, heart rate, and heart rate variability (HRV).
Main Results:
- 78% of patients reported significant symptom improvement within 7 days of ivabradine therapy.
- Ivabradine significantly reduced 24-hour heart rate (minimum, average, maximum) (p<0.0001).
- Significant improvements in HRV time-domain parameters (SDNN, rMSSD) were observed (p<0.0001).
Conclusions:
- Ivabradine treatment led to symptom improvement in post-COVID-19 POTS patients within 7 days.
- Ivabradine significantly reduced heart rate and improved HRV in patients with COVID-19-associated POTS.
- Ivabradine shows promise for managing tachycardia symptoms in COVID-19 POTS, warranting further research.
Background:
A wide range of cardiac arrhythmias were reported in the setting of active infection or as a complication of COVID-19. The main pathophysiology can be attributed to dysautonomia or autonomic nervous system dysfunction. Postural orthostatic tachycardia syndrome (POTS) is a complex, multisystemic disorder affecting usually younger age with tachycardia at rest or with minimal effort being the main symptom. Data regarding the safety and efficacy of ivabradine in POTS treatment is limited to small studies and case reports.
Methods:
This prospective observational study included a total of 55 COVID-19-associated POTS patients after the exclusion of other causes of tachycardia. Ivabradine 5 mg twice daily was initiated. Re-assessment of patients' symptoms, heart rate, and heart rate variability (HRV) parameters' changes after 3 days of ivabradine therapy was done.
Results:
The mean age of the included patients was 30.5±6.9 years with 32 patients being males (58.2%). 43 of 55 (78%) of the included patients reported significant improvement of the symptoms within 7 days of ivabradine therapy. 24-hour heart rate (minimum, average, and maximum) was significantly lower (p-value < 0.0001*, = 0.001*, < 0.0001* consecutively) with a significant difference in HRV time-domain parameters (SDNN, rMSSD) (p-value < 0.0001*) after ivabradine therapy.
Conclusion:
In a prospective study that evaluated the effects of ivabradine in post-COVID-19 POTS, patients treated with ivabradine reported improvement of their symptoms within 7 days of ivabradine treatment with a significant reduction of 24-hour average, minimum, and maximum heart rate, and improvement of HRV time domains parameters. Ivabradine might be a useful option to relieve symptoms of tachycardia in COVID-19 POTS. Further research is required to confirm the safety and efficacy of ivabradine in POTS treatment.
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