Novel approaches to heart rate modulation in chronic heart failure

Abstract

Copyright © Polskie Towarzystwo Kardiologiczne INTRODUCTION The most recent version of the European Society of Cardiology (ESC) Guidelines for the management of heart failure (HF) has introduced two important innovations for the medical treatment of chronic HF with reduced ejection fraction (EF): mineralo-corticoid receptor antagonists (MCRA) and the If channel blocker ivabradine have now a recognised indication in patients remaining symptomatic despite diuretics, angiotensin converting enzyme inhibitors (or angiotensin receptor blockers in case of intolerance) and beta-blockers [1]. Mineralo-corticoid receptor antagonists are recommended following the EMPHASIS trial which demonstrated the benefit of eplerenone on cardiovascular mortality or HF hospitalisations as well as on all causes mortality in mild to moderate HF patients with reduced EF [2]. According to the ESC Guidelines, ivabradine should be considered when patients remain symptomatic despite the addition of a MCRA and when they have an increased heart rate (HR) ≥ 70 bpm in the context of sinus rhythm. This new recommendation derives from the results of the large outcome trial using this new agent, the SHIFT trial (Systolic Heart Failure Treatment with the If inhibitor Ivabradine trial) [3].