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Ten-Year Results of a Single-Center Trial Investigating Heart Rate Control with Ivabradine or Metoprolol Succinate in

Fabrice F Darche1,2, Alexandra C Alt1, Rasmus Rivinius1,2

  • 1Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany.

Journal of Cardiovascular Development and Disease
|August 27, 2025
PubMed

Insights

Ivabradine significantly reduced heart rate and NT-proBNP levels in heart transplant recipients (HTX). This led to improved 10-year survival rates, particularly reducing mortality from graft failure compared to metoprolol succinate.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Pharmacology

Background:

  • Sinus tachycardia post-heart transplantation (HTX) due to graft denervation is linked to poorer survival outcomes.
  • Effective heart rate control is crucial for managing post-HTX complications and improving patient prognosis.

Purpose of the Study:

  • To evaluate the long-term (10-year) efficacy of ivabradine versus metoprolol succinate for heart rate control in HTX recipients.
  • To compare the impact of these heart rate-lowering agents on post-transplant survival and related outcomes.

Main Methods:

  • Observational, retrospective, single-center study involving 110 HTX patients.
  • Patients were treated with either ivabradine (n=54) or metoprolol succinate (n=56).
  • Analysis included demographics, medications, heart rate, blood pressure, echocardiography, cardiac biomarkers, and survival data over 10 years.

Main Results:

  • Ivabradine group showed significantly lower heart rate (72.7 bpm vs. 80.1 bpm) and NT-proBNP levels (588.4 pg/mL vs. 1229.0 pg/mL) at 10-year follow-up compared to metoprolol succinate.
  • Overall mortality was significantly lower in the ivabradine group (20.4% vs. 46.4%; p=0.004).
  • Mortality due to graft failure was markedly reduced with ivabradine (1.9% vs. 21.4%; p=0.001), with multivariate analysis confirming a decreased risk of death (HR 0.374; p=0.008).

Conclusions:

  • Ivabradine demonstrated superior efficacy in heart rate reduction and lowering NT-proBNP levels in HTX recipients over 10 years.
  • Treatment with ivabradine was associated with significantly improved 10-year survival after heart transplantation compared to metoprolol succinate.
  • These findings suggest ivabradine as a beneficial therapeutic option for managing sinus tachycardia and improving long-term outcomes in HTX patients.

Keywords:
heart transplantationivabradinemetoprolol succinatemortalitysinus tachycardiasurvival

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