Ivabradine, a novel heart rate slower: Is it a sword of double blades in patients with idiopathic dilated cardiomyopathy?

Objective: To prospectively assess the safety and efficacy of ivabradine in patients with idiopathic dilated cardiomyopathy. Methods: We included 35 patients with idiopathic dilated cardiomyopathy with an ejection fraction (EF) 40% and heart rate 70 beats/min despite optimal medical therapy, according to the international guidelines in this prospective, non-randomized, single-arm, open-label safety study. Ivabradine was used as an add-on therapy to the maximally tolerated Beta-blocker in an increasing titrated dose till a target dose of 15 mg/ day or resting heart rate of 60 beats/min for 3 months. During follow-up period the safety, patient tolerance and efficacy of this drug were assessed. All patients underwent 12-lead resting electrocardiography and Holter monitoring at inclusion and after 3 months. Statistical analysis was accomplished using paired t-test and Pearson correlation analysis. Results: We found a significant reduction in the resting heart rate by a mean of 25.9±9.4%, without a significant change of blood pressure. There was no prolongation of PR, QTc or QRS durations. Ventricular ectopic activity showed significant reduction (p 0.001). There was a significant correlation between the resting heart rate, NYHA and left ventricular ejection fraction (p 0.001 for both). One patient developed photopsia and decompensation was observed in another patient. Conclusion: Ivabradine is a safe and effective drug in reducing resting heart rate, improving NYHA functional class without undesirable effects on conduction parameters or ectopic activity.