Ivabradine: potential clinical applications in critically ill patients.
It has been extensively demonstrated that an elevated heart rate is a modifiable, independent risk factor for cardiovascular events. A high heart rate increases myocardial oxygen consumption and reduces diastolic perfusion time. It can also increase ventricular diastolic pressures and induce ventricular arrhythmias. Critical care patients are prone to develop a stress induced cardiac impairment and consequently an increase in sympathetic tone. This in turn increases heart rate. In this setting, however, heart rate lowering might be difficult because the effects of inotropic drugs could be hindered by heart rate reducing drugs like beta-blockers. Ivabradine is a new selective antagonist of funny channels. It lowers heart rate, reducing the diastolic depolarization slope. Moreover, ivabradine is not active on sympathetic pathways, thus avoiding any interference with inotropic amines. We reviewed the literature available regarding heart rate control in critical care patients, focusing our interest on the use of ivabradine to assess the potential benefits of the drug in this particular setting.
Department of Anesthesiology and Intensive Care, Azienda USL di Ravenna, Viale Randi 5, 48121, Ravenna, Italy. desantis.desantis@gmail.com
Vincenzo
V
De Santis
Domenico
D
Vitale
Anna
A
Santoro
Aurora
A
Magliocca
Andrea Giuseppe
AG
Porto
Cecilia
C
Nencini
Luigi
L
Tritapepe
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000503:physiopathology; D016638:Critical Illness; D004347:Drug Interactions; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D000077550:Ivabradine; D009200:Myocardial Contraction / Q000187:drug effects; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology; D016896:Treatment Outcome; D016276:Ventricular Function / Q000187:drug effects
D000889:Anti-Arrhythmia Agents; D001552:Benzazepines; D002316:Cardiotonic Agents; D000077550:Ivabradine