Abstract
Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by symptoms such as palpitations, dyspnea, chest discomfort, and lightheadedness affecting various systems. The pathophysiology of POTS is not completely understood due to a variety of symptoms showing that the disease is multifactorial. There is no approved uniform management strategy for POTS and hence, no drug has been approved by the United States (US) Food and Drug Administration (FDA) for it. Ivabradine is an FDA-approved drug for stable symptomatic heart failure (HF) and patients with an ejection fraction (EF) of ≤35%. Previous studies have depicted improvement in symptoms of POTS with the use of ivabradine. It is a selective inhibitor of funny sodium channels (If) in the sinoatrial (SA) node cells resulting in the prolongation of the slow diastolic depolarization (phase IV) and reduction in the heart rate (HR). Although beta-adrenoceptor blockers are commonly used to lower HR in patients with POTS, they are less ideal due to numerous adverse effects. This review aims to provide a comprehensive and up-to-date picture of all the studies and case reports that utilized ivabradine for the treatment of POTS along with a precise overview of epidemiology, pathophysiology, and types of POTS. To conclude, we recommend further research on the effectiveness of ivabradine in patients who experience symptoms of POTS. Other than stable chronic angina pectoris, its application in this setting has been proven to be effective and safe. Further evaluation by means of randomized control trials is required to encourage use of this HR-lowering agent in common disorders other than HF and stable angina, i.e. POTS.
Highlights
BackgroundThe first informal mention of postural orthostatic tachycardia syndrome (POTS) was by Da Costa, in 1871, who referred to it as “soldier’s heart” or “irritable heart” [1]
This review aims to provide a comprehensive and up-to-date picture of all the studies and case reports that utilized ivabradine for the treatment of Postural orthostatic tachycardia syndrome (POTS) along with a precise overview of epidemiology, pathophysiology, and types of POTS
Sutton et al published a pilot study, in the year 2014, in which the effect of ivabradine was assessed in patients with vasovagal shock who manifested with sinus tachycardia on the head tilt, meeting the heart rate (HR) criteria for POTS [12]
Summary
The first informal mention of postural orthostatic tachycardia syndrome (POTS) was by Da Costa, in 1871, who referred to it as “soldier’s heart” or “irritable heart” [1]. Beta-adrenoceptor blockers are commonly used to lower HR in patients with POTS; they are less ideal due to numerous AEs. not FDA approved, previous studies have depicted improvement in symptoms of POTS with the use of ivabradine. Sutton et al published a pilot study, in the year 2014, in which the effect of ivabradine was assessed in patients with vasovagal shock who manifested with sinus tachycardia on the head tilt, meeting the HR criteria for POTS [12]. Half (55%) of the patients continued the use of ivabradine at the time of analysis with a mean duration of 25 weeks and mean drug dosage of 5 mg in a single dose or two doses, and reported decreased episodes of palpitations and tachycardia.
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