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47 SHORT COMMUNICATION Ivabradine in Postural Orthostatic Tachycardia Syndrome: Preliminary Experience in Children Grazia Delle Donne 1 • Ferran Rose´s Noguer 1,3 • Jan Till 1 • Tushar Salukhe 1 • Sanjay K. Prasad 1,2 • Piers E. F. Daubeney 1,2 Published online: 13 October 2017 Springer International Publishing AG 2017 Abstract Objective Ivabradine is a selective and specific inhibitor of the I(f) current in the sinoatrial and atrioventricular nodes. It decreases heart rate and myocardial oxygen consumption at rest and during exercise. It is used in adults for man- agement of heart failure and angina, but promising results have been obtained in postural orthostatic tachycardia syndrome (POTS). There is little experience of ivabradine in childhood, although it is used on a compassionate basis. Our aim was to review our experience of ivabradine in a retrospective evaluation of pediatric patients with POTS. Methods We evaluated all patients younger than 18 years for whom ivabradine had been prescribed for this indica- tion, from February 2008 to June 2014. Results Twenty-two patients were identified (15 female). Median age was 14.5 years (11–17 years). The ivabradine dosage after up-titration was 0.1 mg/kg per dose twice daily. In 15 (68%) symptoms improved. Ivabradine was suspended in five, but only in one for worsening of symptoms. There was a reduction in heart rate on resting electrocardiogram (EKG) from a mean (standard deviation) of 82.5 (13.6) bpm to a mean of 71 (16.5) bpm ( p = 0.007). No patient had increased duration of QTc ( p = 0.44). One (4.5%) experienced phosphenes. Conclusions From this initial experience, ivabradine is safe in patients younger than 18 years with POTS. We observed improvement of symptoms in 68% and phosphenes in less than 5%. Further studies are needed to assess the safety in a randomized control setting. Key Points Ivabradine is safe in the pediatric population. Ivabradine improves symptoms in patients with postural orthostatic tachycardia syndrome. 1 Introduction Ivabradine is a selective and specific inhibitor of the I(f) current in the sinoatrial node and atrioventricular node. The I(f) current controls the spontaneous electrical pace- maker activity in the sinoatrial node. Ivabradine decreases the heart rate and thereby the myocardial oxygen con- sumption at rest and during exercise. It is used in the adult population for management of heart failure and angina [ 1 , 2 ]. Ivabradine has also been used in patients with postural orthostatic tachycardia syndrome (POTS), show- ing good results in improving symptoms [ 3 , 4 ]. Whereas ivabradine is used in the adult population, little is known about it in the pediatric population. Recently, Bonnet et al. [ 5 ] published a multicenter study establishing the efficacy of ivabradine in reducing heart rate in children with dilated cardiomyopathy. The aim of this descriptive retrospective study was to review the efficacy and safety of ivabradine in children with POTS. This was an observa- tional study and no attempt was made to influence the & Piers E. F. Daubeney p.daubeney@rbht.nhs.uk 1 Royal Brompton Hospital, Sydney St, London SW3 6NP, UK 2 Imperial College, London, UK 3 Vall d’Hebron University Hospital, Barcelona, Spain Am J Cardiovasc Drugs (2018) 18:59–63 https://doi.org/10.1007/s40256-017-0248-x management of t making. The patie compassionate bas benefits and side e their parents. 2 Methods We evaluated pa institution for who February 2008 to pharmacy databas starting the medi POTS was specifi heart rate increase 120 bpm within t with symptoms significant orthost age at commence up-titration, reaso treatment, medica medications with worsening of sym and at follow-up cardiogram (EKG dine and at follo 2.1 Statistical An Normally distribut and standard devi were described w pendent t test was nificant level was T ble 1 Demographi clinician’s stated indi starting ivabradine 60