Abstract 12717: If Channel Blocker Ivabradine Counteracts Underisable Tachycardia in Patients Supported With Inotropic Agents
Introduction: The utilization of inotropic agents is usually linked to development of unappropriated and undesirable sinus tachycardia. That use also increases the myocardial oxygen consumption, could develop ischemic events and also has pro arrhythmic effects in coronary patients with acute heart failure, existing limited therapeutic options to face that situation.
Hypothesis: The If channels blocker Ivabradine could be useful and safe for counteract the sinus tachycardia induced by inotropic agents and its undesirable effects without affecting the positive inotropic effect.
Methods: Patients with ischemic-necrotic cardiomyopathy and low ejection fraction (under 35%) admitted for acute decompensation of heart failure with requirement of inotropic agents were prospectively and consecutively included.
Patients with a rhythm different than sinus rhythm, impossibility for place a Swan-Ganz catheter or unable to use the oral route were excluded. Hemodynamic measurements with Pulmonary Artery catheters were performed before and three hours after oral administration of 15mg of Ivabradine.
Results: The study included 52 patients (32 males and 20 females) with an average age of 65.6 years and an ejection fraction of 31.5% whe were under treatment with an average dose of 15 mcg/kg of Dobutamine. Three hours after started Ivabradine, it was observed a reduction of the heart rate from 123 +/-6 to 96+/-7 beats per minute (P=0.00002) with an increment of the systolic volume from 37.9+/-5 ml to 47.3+/-8 ml (P=0.00002) and the cardiac output from 4597 +/-550 ml/minute to 4825+/-535 ml/minute (P=0.041). No differences were observed nor in the filling pressures neither in the systemic or pulmonary resistances.
There was a good clinical tolerance without evidence of hypotension, bradycardia, atrioventricular block episodes or need for transitory pacemaker .
Conclusions: Ivabradine was an useful and safe intervention for controlling the undesirable sinus tachycardia linked to inotropic agents in patients with ischemic-necrotic cardiomyopathy. The drug didn’t affects the positive effect over contractility.
Author Disclosures: R. Levin: None. M. Degrange: None. A. Botbol: None. M. Levin Degrange: None. G. Perez Baztarrica: None. F. Salvagio: None. R. Porcile: None.
- © 2015 by American Heart Association, Inc.