PO-638-01 THE FUTURE OF ACLS: IVABRADINE’S ROLE FOR THE TREATMENT OF REFRACTORY VENTRICULAR ARRHYTHMIAS

Abstract

Ivabradine (IVA) is an attractive antiarrhythmic for the treatment of refractory ventricular arrhythmias (RVA) as it does not affect blood pressure or prolong the QT interval. IVA's efficacy in ventricular tachycardia (VT)/ventricular fibrillation (VF) has been validated in multiple animal studies. We present a case series demonstrating complete resolution of RVA in humans with the addition of IVA. Illustrate the outcomes of RVA with the treatment of IVA. Retrospective case series analysis of 4 patients treated with IVA for RVA. Pt 1: 63M with ischemic cardiomyopathy was admitted for RVA despite amiodarone, quinidine, and a beta blocker. IVA 2.5mg BID was initiated with resolution of VF. Pt 2: 61F was admitted with cardiogenic shock secondary to giant cell myocarditis complicated with VT/VF. IVA 2.5mg BID was initiated for RVA despite amiodarone and quinidine. IVA was up titrated to 5mg BID with resolution of VT/VF. Pt 3: 58M without significant history was admitted with a VF arrest. The addition of IVA 2.5mg BID to amiodarone, quinidine, and procainamide resolved VF burden. Pt 4: 37M with cardiomyopathy with continued VT / VF despite amiodarone, and lidocaine, and Impella mechanical circulatory support. IVA 2.5mg BID was initiated, and lidocaine was weaned. These therapies stabilized his rhythm, allowing for successful left ventricular assist device implant. All four patients’ RVA (Images A, C, E, G) were converted to sinus rhythm (Images B, D, F, H) with the addition of IVA to standard antiarrhythmic drugs (Table 1/Figure 1). IVA may be a beneficial additive treatment for RVA. However, randomized studies are required to determine the clinical success of RVA attenuation with IVA.