title: Is ivabradine suitable to control undesirable tachycardia induced by dobutamine in cardiogenic shock treatment?
abstract: Inotropic treatment remains the cornerstone for cardiogenic shock, an emergency that requires immediate resuscitative therapy before shock irreversibly damages vital organs. Although the sympathomimetic drug dobutamine is the most widely-used inotropic drug worldwide, it has several side effects including sinus tachycardia. Dobutamine partly restores systolic heart failure (HF); however, it increases the heart rate (HR) which counterbalances the beneficial effects. Ivabradine, a new selective If inhibitor, provides specific HR reduction and is indicated in stable coronary artery disease and in stable chronic HF with left ventricular dysfunction. Despite scarce data indicating beneficial effects of ivabradine in sinus tachycardia in various clinical settings, this drug remains contraindicated in acute HF. We propose that ivabradine could help to prevent the dobutamine-induced side effects, and that their combination in clinical practice could lead to pure inotropic effects, useful for the management of cardiogenic shock.
authors.affiliation: Montreal Heart Institute, Montreal, QC, Canada. francois.roubille@gmail.com
authors.forename: François
authors.initials: F
authors.lastname: Roubille
authors.forename: Benoît
authors.initials: B
authors.lastname: Lattuca
authors.forename: David
authors.initials: D
authors.lastname: Busseuil
authors.forename: Florence
authors.initials: F
authors.lastname: Leclercq
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Davy
authors.forename: Eric
authors.initials: E
authors.lastname: Rhéaume
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
mesh_terms: D001552:Benzazepines / Q000627:therapeutic use*; D004280:Dobutamine / Q000009:adverse effects*; D006801:Humans; D000077550:Ivabradine; D008962:Models, Theoretical; D013610:Tachycardia / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D001552:Benzazepines; D000077550:Ivabradine; D004280:Dobutamine
keywords: ACE; ARB; BPM; HCN; HF; HR; LVEF; MODS; MRA; angiotensin II receptor antagonist; angiotensin converting enzyme; beats per minute; heart failure; heart rate; hyperpolarization-activated cyclic nucleotide-gated cation channels; left ventricular ejection fraction; mineralocorticoid receptor antagonist; multiple organ dysfunction syndrome