If current inhibition with ivabradine: further perspectives

Abstract

Beyond its antianginal properties, the specific If (pacemaker, or ‘funny’, current) channel blocker ivabradine has many possible clinical uses. The first potential application of ivabradine results from its ability to decrease myocardial ischaemia. Because myocardial ischaemia has a definite impact on outcome, its reduction is likely to improve prognosis in patients with coronary artery disease (CAD). In such patients, lowering the heart rate per se might also reduce risk for sudden cardiac death or acute coronary events, as a strong link exists between heart rate and plaque rupture, which is the triggering mechanism of most complications of CAD. Most importantly, If current inhibition might be useful in patients with congestive heart failure. In such patients, there is a parallel between heart rate reduction and the beneficial clinical effects achieved with beta-blockers. Observational studies, on the other hand, show that only a minority of patients with heart failure receive beta-blockers; If current inhibition might constitute an alternative in such patients. Diastolic heart failure remains a therapeutic challenge, and prolonging the diastolic time is likely to prove beneficial. Because ivabradine has no negative impact on left ventricular function, it might also be useful for controlling heart rate in patients with acute heart failure treated with agents such as dobutamine. Future studies will determine whether ivabradine fulfils part, or all, of this promise.