Physiological basis of therapeutic approach to ivabradine use in new acute onset heart failure

Abstract

Background and Aim: Ivabradine is a selective and specific inhibitor of the sinus node funny current (I f ) channel with negative chronotropic properties while not affecting inotropy. Though the benefit of ivabradine in patients with coronary artery disease and chronic heart failure is well-established, data of its usage in acute heart failure (AHF) is scarce. We investigated the potential role of ivabradine in patients with acute ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention that postprocedurally present in hypoperfusion state without having complete criteria for cardiogenic shock, a state known as preshock or gray zone of cardiogenic shock, which is often associated with anterior STEMI and 46% in-hospital mortality. Methods: During 2010, we conducted this pilot study on patients with acute STEMI where the culprit lesion was left anterior descending artery, complicated by the preshock. Altogether 10 patients (8 male and 2 female patients) were treated with ivabradine as an additional therapy who had stable sinus tachycardia. Their heart rate (HR), blood pressure (BP), degree of diuresis, and overall clinical response were recorded before and after ivabradine therapy. Results: We observed a drop in HR from average 116−78/min, a rise in systolic BP from 99−108 mm Hg and a rise in diuresis from 55 to 85 mL/h within the first 48 h. Conclusion: Early observational data support use of ivabradine in STEMI with advanced AHF. We propose that ivabradine could help STEMI patients in grey zone of cardiogenic shock (preshock).