Hemodynamic Effect of Ivabradine in Young Girl with Acute Heart Failure

Abstract

<h3>Introduction</h3> Few data are currently available on the use of Ivabradine in children with heart failure (HF). This medication has recently proved to be useful in decreasing heart rate (HR) and in improving left ventricular (LV) function in pediatric population with chronic HF. No data are reported in case of advanced HF and/or in acute phase. <h3>Case Report</h3> We report a case of a 12-year-old girl affected by dilated/LV non-compaction cardiomyopathy and Wolf-Parkinson-White syndrome (WPWS) and presenting with acute HF admitted to Intensive care. At admission, she presented with clinical signs of inadequate perfusion (vasoconstriction, pallor, sweating, cool extremities) and pulmonary rales (cold-wet phenotype). The pro-NT-BNP was 10650 pg/ml. Echocardiography demonstrated a markedly dilated LV with severe systolic dysfunction (LVEF 17%) and a mildly dilated left atrium and moderate-severe mitral insufficiency. The right ventricle was quite normal with mild tricuspid insufficiency with normal PSVD. Intravenously medical treatment was started with dopamine [6 mcg/kg/min], milrinone [0,5 mcg/kg/min], furosemide. After dopamine weaning, the patient was still tachycardic and echocardiography confirmed EF of 14%. Ivabradine was started at 2,5 mg twice a day in PICU setting. After introduction of ivabradine we observed an acute reduction of heart rate from 97 to 70 bpm in 24 h. The hourly hemodynamic monitoring with MOST care ® showed an increase of Cardiac Index from 2.0 (at baseline) to 3.0 after 24 h and an increase of Stroke volume from 35 ml to 60 ml after 24 h. No changes in blood pressure were reported [figure 1] <h3>Summary</h3> Our case suggests that in children with advanced HF and markedly depressed LV function, the acute administration of ivabradine is well tolerated. Ivabradine seems a favourable approach for treatment of children with advanced heart failure, effective in reduction of HR, able to increase stroke volume and cardiac output. Further studies are required to assess the feasibility and efficacy of this drug.