Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-26T13:14:51.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Ivabradine in children with postural orthostatic tachycardia syndrome: a retrospective study

Published online by Cambridge University Press:  05 June 2020

Arooge Towheed Open the ORCID record for Arooge Towheed [Opens in a new window] ,
Zeid Nesheiwat ,
Muhammad A Mangi ,
Beverly Karabin  and
Blair P Grubb
Arooge Towheed*
Affiliation:
Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA
Zeid Nesheiwat
Affiliation:
Department of Internal Medicine, University of Toledo, Toledo, OH, USA
Muhammad A Mangi
Affiliation:
Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA
Beverly Karabin
Affiliation:
Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA
Blair P Grubb
Affiliation:
Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA
*
Author for correspondence: Arooge Towheed, Division of Cardiovascular Diseases, The University of Toledo, 3000 Arlington Avenue, 43614, MS 1118, Toledo, OH, USA. Tel: +1 419 383 1245; Fax: +1 419 383 3041. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Ivabradine is a unique medication that reduces the intrinsic heart rate by specifically blocking the inward funny current that controls the pacemaker activity of the sinus node. We conducted a retrospective cohort study to assess the efficacy of ivabradine in children suffering from postural orthostatic tachycardia syndrome.

Methods:

A chart review was conducted of patients less than 18 years of age who were diagnosed with postural orthostatic tachycardia syndrome who had received ivabradine as treatment from January 2015 to February 2019 at our institution. Twenty-seven patients (25 females, 92.5%) were identified for the study. The outcomes which were assessed included a change in the severity and frequency of symptoms, heart rate, and blood pressure before and after starting ivabradine.

Results:

There was an improvement in the symptoms of 18 (67%) out of 27 patients. The most notable symptom affected was syncope/presyncope with a reduction in 90%, followed by lightheadedness (85%) and fatigue (81%). The vital signs of the patients showed an overall significant lowering of the heart rate during sitting (89.7 ± 17.9 versus 73.2 ± 12.1; p-value <0.05) and standing (100.5 ± 18.1 versus 80.9 ± 10.1; p-value <0.05) without a significant change in the blood pressure. Two patients had visual disturbances (luminous phenomena). Severe bradycardia and excessive flushing were seen in two patients, respectively. Another one patient reported joint pain and fatigue.

Conclusion:

This study indicates that 67% of children treated with ivabradine report an improvement in symptoms.

Keywords

Orthostatic intolerancemedicationschildren
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 975 - 979
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Freeman, R, Wieling, W, Axelrod, FB, et al.Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69–72.CrossRefGoogle ScholarPubMed
Sheldon, RS, Grubb, BP, 2nd, Olshansky, B, et al.2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 2015; 12: e41–e63.CrossRefGoogle ScholarPubMed
Arnold, AC, Ng, J, Raj, SR. Postural tachycardia syndrome – diagnosis, physiology, and prognosis. Auton Neurosci 2018; 215: 3–11.CrossRefGoogle ScholarPubMed
Low, PA, Sandroni, P, Joyner, M, Shen, WK. Postural tachycardia syndrome (POTS). J Cardiovasc Electrophysiol 2009; 20: 352–358.CrossRefGoogle Scholar
Carew, S, Connor, MO, Cooke, J, et al.A review of postural orthostatic tachycardia syndrome. Europace 2009; 11: 18–25.CrossRefGoogle ScholarPubMed
Boris, JR, Bernadzikowski, T.Demographics of a large paediatric Postural Orthostatic Tachycardia Syndrome Program. Cardiol Young 2018; 28: 668–674.CrossRefGoogle ScholarPubMed
Boris, JR, Bernadzikowski, T.Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome. Cardiol Young 2018; 28: 1386–1392.CrossRefGoogle ScholarPubMed
McDonald, C, Frith, J, Newton, JL.Single centre experience of ivabradine in postural orthostatic tachycardia syndrome. Europace 2011; 13: 427–430.CrossRefGoogle ScholarPubMed
Sutton, R, Salukhe, TV, Franzen-McManus, AC, Collins, A, Lim, PB, Francis, DP.Ivabradine in treatment of sinus tachycardia mediated vasovagal syncope. Europace 2014; 16: 284–288.CrossRefGoogle ScholarPubMed
Ruzieh, M, Sirianni, N, Ammari, Z, et al.Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience. Pacing Clin Electrophysiol 2017; 40: 1242–1245.CrossRefGoogle ScholarPubMed
Delle Donne, G, Roses Noguer, F, Till, J, Salukhe, T, Prasad, SK, Daubeney, PEF.Ivabradine in postural orthostatic tachycardia syndrome: preliminary experience in children. Am J Cardiovasc Drugs 2018; 18: 59–63.CrossRefGoogle ScholarPubMed
Bryarly, M, Phillips, LT, Fu, Q, Vernino, S, Levine, BD.Postural orthostatic tachycardia syndrome: JACC focus seminar. J Am Coll Cardiol 2019; 73: 1207–1228.CrossRefGoogle ScholarPubMed
AMGEN Pharmaceutical Companies. Corlanor(Ivabradine) Highlights of Prescribing Information. United States of America Food and Drug Administration. Retrieved January 26, 2020, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/206143Orig1s000lbl.pdfGoogle Scholar
Bucchi, A, Baruscotti, M, DiFrancesco, D.Current-dependent block of rabbit sino-atrial node I(f) channels by ivabradine. J Gen Physiol 2002; 120: 1–13.CrossRefGoogle ScholarPubMed
Barzilai, M, Jacob, G.The effect of ivabradine on the heart rate and sympathovagal balance in postural tachycardia syndrome patients. Rambam Maimonides Med J 2015; 6: e0028.CrossRefGoogle ScholarPubMed
Kanjwal, K, Karabin, B, Sheikh, M, et al.Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience. Pacing Clin Electrophysiol 2011; 34: 750–755.CrossRefGoogle ScholarPubMed
Thieben, MJ, Sandroni, P, Sletten, DM, et al.Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc 2007; 82: 308–313.CrossRefGoogle ScholarPubMed
Bonnet, D, Berger, F, Jokinen, E, Kantor, PF, Daubeney, PEF.Ivabradine in children with dilated cardiomyopathy and symptomatic chronic heart failure. J Am Coll Cardiol 2017; 70: 1262–1272.CrossRefGoogle ScholarPubMed
Al-Ghamdi, S, Al-Fayyadh, MI, Hamilton, RM.Potential new indication for ivabradine: treatment of a patient with congenital junctional ectopic tachycardia. J Cardiovasc Electrophysiol 2013; 24: 822–824.CrossRefGoogle ScholarPubMed
Romeo, E, Grimaldi, N, Sarubbi, B, et al.A pediatric case of cardiomyopathy induced by inappropriate sinus tachycardia: efficacy of ivabradine. Pediatr Cardiol 2011; 32: 842–845.CrossRefGoogle ScholarPubMed
Cervetto, L, Demontis, GC, Gargini, C.Cellular mechanisms underlying the pharmacological induction of phosphenes. Br J Pharmacol 2007; 150: 383–390.CrossRefGoogle ScholarPubMed
Cocco, G, Jerie, P.Torsades de pointes induced by the concomitant use of ivabradine and azithromycin: an unexpected dangerous interaction. Cardiovasc Toxicol 2015; 15: 104–106.CrossRefGoogle ScholarPubMed