title: Ivabradine, a novel heart rate slower: is it a sword of double blades in patients with idiopathic dilated cardiomyopathy?
abstract: OBJECTIVE
  To prospectively assess the safety and efficacy of ivabradine in patients with idiopathic dilated cardiomyopathy.
  
  
  METHODS
  We included 35 patients with idiopathic dilated cardiomyopathy with an ejection fraction (EF) <40% and heart rate >70 beats/min despite optimal medical therapy, according to the international guidelines in this prospective, non-randomized, single-arm, open-label safety study. Ivabradine was used as an add-on therapy to the maximally tolerated b-blocker in an increasing titrated dose till a target dose of 15 mg/day or resting heart rate of 60 beats/min for 3 months. During follow-up period the safety, patient tolerance and efficacy of this drug were assessed. All patients underwent 12-lead resting electrocardiography and Holter monitoring at inclusion and after 3 months. Statistical analysis was accomplished using paired t-test and Pearson correlation analysis.
  
  
  RESULTS
  We found a significant reduction in the resting heart rate by a mean of 25.9 ± 9.4%, without a significant change of blood pressure. There was no prolongation of PR, QTc or QRS durations. Ventricular ectopic activity showed significant reduction (p<0.001). There was a significant correlation between the resting heart rate, NYHA and left ventricular ejection fraction (p<0.001 for both). One patient developed photopsia and decompensation was observed in another patient.
  
  
  CONCLUSIONS
  Ivabradine is a safe and effective drug in reducing resting heart rate, improving NYHA functional class without undesirable effects on conduction parameters or ectopic activity.
authors.affiliation: Department of Cardiology, Ain Shams University, Cairo-Egypt. monarayan17@yahoo.com
authors.forename: Mona
authors.initials: M
authors.lastname: Rayan
authors.forename: Mazen
authors.initials: M
authors.lastname: Tawfik
authors.forename: Ali
authors.initials: A
authors.lastname: Alabd
authors.forename: Amr
authors.initials: A
authors.lastname: Gamal
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D001552:Benzazepines / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D000077261:Carvedilol; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use; D011446:Prospective Studies; D013148:Spironolactone / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D018879:Ventricular Premature Complexes / Q000188:drug therapy
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D001552:Benzazepines; D002227:Carbazoles; D002316:Cardiotonic Agents; D004232:Diuretics; D011412:Propanolamines; D014665:Vasodilator Agents; D000077261:Carvedilol; D013148:Spironolactone; D000077550:Ivabradine; D004077:Digoxin