Ivabradine may revolutionize rate control in Rheumatic Atrial Fibrillation

A potential game-changer in the management of Rheumatic atrial fibrillation (AF) has emerged, with Ivabradine taking the spotlight as a promising agent for controlling heart rates in patients suffering from this cardiac condition. The breakthrough comes as a result of Ivabradine's influence on HCN channels within the atrioventricular (AV) node. 

The study results were published in the Indian Heart Journal on September 2, 2023. 

Rheumatic heart disease is the common cause of Atrial fibrillation and it is a significant concern in cardiovascular medicine. Rate control is a crucial aspect of managing AF and it is a default treatment strategy. Ivabradine is a novel heart rate-reducing agent, now demonstrating remarkable potential in this area. 

Researchers from the Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014, India conducted a prospective single-center, randomized study to assess the safety and efficacy of Ivabradine as add-on therapy for rate control in patients with persistent and/or permanent rheumatic AF and already on maximally tolerated doses of either ββ or CCB.

About 80 patients diagnosed with rheumatic AF, having a heart rate exceeding 100 beats per minute, showed promising results. Patients were randomized to either continue their existing medication regimen, typically beta-blockers or calcium channel blockers, or switch to Ivabradine. Ivabradine was introduced at a dose of 2.5 mg twice daily increased to 5 mg BD if inadequate response at 1 week. Dose escalation to 7.5mg BD was done after Holter at 1 month. 

The results were striking. 

• Significant reduction in heart rates compared to the control group was observed at 3 and 6 months.
• The absolute reduction in heart rate and percentage change were both notably higher in the Ivabradine group.
• Additionally, at the 6-month mark, the Ivabradine-treated patients experienced lower NT Pro BNP levels, improved exercise tolerance, better symptom relief, and enhanced left atrial strain, all of which indicated improved cardiac function and overall well-being.
• Crucially, Ivabradine was well-tolerated, with no reported cases of drug withdrawal.

This suggests that Ivabradine may be a viable option for rate control in rheumatic AF, potentially offering a more effective and patient-friendly alternative to current therapies. Ivabradine could herald a new era in the management of atrial fibrillation, offering hope for improved quality of life and better cardiac health for millions of individuals affected by this condition. 

Further reading: A pilot study evaluating the role of ivabradine for rate control in patients with rheumatic atrial fibrillation. https://doi.org/10.1016/j.ihj.2023.08.006