Single centre experience of ivabradine in postural orthostatic tachycardia syndrome.
OBJECTIVE
Postural orthostatic tachycardia syndrome (POTS) is associated with tachycardia on orthostasis. Patients frequently report palpitations, presyncope, and fatigue. Conventional therapy is effective in less than 60%. Case reports suggest ivabradine (a selective sinus node blocker, with no effect on blood pressure) may alleviate POTS-related symptoms. This is a retrospective case-series.


RESULTS
Postural orthostatic tachycardia syndrome patients prescribed ivabradine were identified from the pharmacy database. Case notes were reviewed and participants completed a symptom assessment tool. Twenty-two patients were identified. Data were available from 20. Eight patients reported reduced tachycardia and fatigue and four reported only reduced tachycardia. The most common reason for discontinuing ivabradine was lack of efficacy (n = 6). Five patients reported side-effects resulting in two discontinuing treatment.


CONCLUSIONS
This retrospective case series indicates that 60% of patients treated with ivabradine report a symptomatic improvement. A randomized controlled trial accessing the efficacy of ivabradine in POTS is indicated, particularly in patients resistant to, or intolerant of, conventional therapy.
Institute for Ageing and Health, UK NIHR Biomedical Research Centre in Ageing and Age-related Diseases-Cardiovascular theme & Falls and Syncope Service, Newcastle University, Newcastle, UK.
Claire
C
McDonald
James
J
Frith
Julia L
JL
Newton
D000328:Adult; D001552:Benzazepines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016022:Case-Control Studies; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D015994:Incidence; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D054971:Orthostatic Intolerance / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012849:Sinoatrial Node / Q000187:drug effects / Q000503:physiopathology; D013610:Tachycardia / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome
D001552:Benzazepines; D000077550:Ivabradine