Best of heart failure

51 ivabradine was discontinued for no change in symptoms (after 30 days). Sixteen patients were followed up for more than 3 months: in one ivabradine was discontinued for no improvement in symptoms (after 14.5 months) (Table 3 ). In 15 patients (68%), the symptoms improved according to the treating clinician: reduced syncopal episodes and resolution of symptoms (Table 4 ). 3.2 Side Effects One patient (4.5%) experienced mild phosphenes (flashing lights). The ivabradine dosage was slightly reduced, from 10 to 7.5 mg/day, with improvement of the symptoms. No patient experienced symptomatic bradycardia. 3.3 Electrocardiograms EKGs were retrospectively available for analysis in 19 of the 22 patients (86%) after starting ivabradine. Changes to heart rate and QTc are shown in Table 5 . Table 2 Medications taken prior to starting ivabradine. Some were discontinued when it was started Number of medications prior to ivabradine Medication Number of patients 1 Fludrocortisone Beta-blocker Midodrine Sodium supplement 7 2 4 0 2 Fludrocortisone Beta-blocker Midodrine Sodium supplement 1 0 0 1 Table 3 Follow-up (total patients, n = 22) Number of patients Ivabradine discontinued Follow-up \ 3 month 6 4 Follow-up [ 3 months 16 1 Table 4 Evaluation of symptoms after starting ivabradine Improvement Unchanged Deterioration 22 patients 15 (68%) 6 (27%) 1 (4.5%) Ivabradine in POTS: Preliminary Experience in Children 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 Table 1 Demographi clinician’s stated indi starting ivabradi e 60 systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet. 2008;372:817–21. 9. Montalescot G, Sechtem U, Achenbach S, et al. ESC guidelines on the management of stable coronary artery disease. Eur Heart J. 2013;34:2949–3003. 10. Fox K, Ford I, Steg PG et al (SIGNIFY investigators). Ivabradine in stable coronary artery disease without clinical heart failure. N Engl J Med. 2014;371:1091–9. 11. Fox K, Ford I, Steg PG et al. Rationale, design, and baseline characteristics of the Study assessInG the morbidity–mortality benefits of the If inhibitor Ivabradine in patients with coronarY artery disease (SIGNIFY trial): a randomized, double-blind, placebo-controlled trial of ivabradine in patients with stable coronary artery disease without clinical heart failure. Am Heart J. 2013;166:654–61. 12. Fox KM, Ferrari R. Heart rate: a forgotten link in coronary artery disease? Nat Rev Cardiol. 2011;8:369–79. 13. Fox K, Ford I, Steg PG et al (BEAUTIFUL investigators). Relationship between ivabradine treatment and cardiovascular outcome in patients with stable coronary artery disease and left ventricular systolic dysfunction with limiting angina: a subgroup analysis of the randomized controlled BEAUTIFUL trial. Eur Heart J. 2009;30:2337–45. 14. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed i coll bor tion with the Heart Failure Association (HFA) of the ESC. ESC Committee for Practice Guidelines. Eur J Heart Fail. 2012;14:803–69. 15. Fox K, Komajda M, Ford I, et al. Effect of ivabradine in patients with left-ventricular systolic dysfunction: a pooled analysis of individual patient data from the BEATIFUL and SHIFT trial. Eur Heart J. 2013;34:2263–70. 16. Oliphant CS, Owens RE, Bolorunduro OB, et al. Ivabradine: a review of labelled and off-labeled uses. Am J Cardiovasc Drugs. 2016;16:337–47. 17. Khan S, Hamid S, Rinaldi C. Treatment of inappropriate sinus tachycardia with ivabradine in a patient with postural orthostatic tachycardia syndrome and a dual chamber p cema . Pacing Clin Electrophysiol. 2009;32:131–3. 18. Al-Ghamdi S, Al-Fayyadh MI, Hamilton RM. Potential new indication for ivabradine: treatment of a patient with congenital junctional ectopic tachycardia. J Cardiovasc Electro hysiol. 2013;24:822–4. 19. Romeo E, Grimaldi N, Sarubbi B, et al. A pediatric case of cardiomyopathy induced by inappropriate sinus tachycardia: efficacy of ivabradine. Pediatr Cardiol. 2011;32:842–5. 20. Cervetto L, Demontis GC, Gargini C. Cellular mechanisms underlying the pharmacological induction of phosphenes. Br J Pharmacol. 2007;150:383–90. 21. Savelieva I, Camm AJ. If inhibition with ivabradine: electo- physiological effect and safety. Drug Saf. 2008;31:95–107. Ivabradine in POTS: Preliminary Experience in Children 63