Favourable effects of heart rate reduction with intravenous administration of ivabradine in patients with advanced heart failure

Background: Heart rate (HR) reduction may be useful in treatment of patients with heart failure (HF). There are no data on the haemodynamic effects of ivabradine (a selective I_f current inhibitor) in advanced HF patients. Aims: To assess the haemodynamic effects of ivabradine in patients with advanced HF and markedly depressed left ventricular (LV) function. Methods and results: Ten NYHA class III patients (50 ± 12 years, LV ejection fraction 21 ± 7%) underwent 24-h haemodynamic monitoring. Ivabradine 0.1 mg/kg was infused over 90′, followed by 0.05-0.075 mg/kg in the subsequent 90′. Baseline HR was 93 ± 8 bpm, cardiac index (CI) 2.2 ± 0.6 l/min^*m²; LV stroke volume 44 ± 11 ml and systolic work 39 ± 13 g. Ivabradine significantly reduced HR, by a maximum of 27% (to 68 ± 9 bpm) at 4 h, without decreasing CI. Ivabradine increased stroke volume and LV systolic work by a maximum of 51% (to 66 ± 17 ml) and 53% (to 58 ± 20 g) at 4 h. No serious adverse events occurred. Conclusion: In patients with advanced HF and markedly depressed LV function, the acute administration of ivabradine is well tolerated, effectively reduces HR, markedly increases stroke volume and preserves cardiac output. Ivabradine appears a promising approach for the treatment of patients with moderate and advanced heart failure.