title: Intravenous ivabradine for control of heart rate during coronary CT angiography: A randomized, double-blind, placebo-controlled trial.
abstract: BACKGROUND
  Low heart rates (HRs) are preferable for coronary CT angiography (CTA). We evaluated the use of an intravenous bolus of ivabradine, a selective sinus node inhibitor, to lower HR before coronary CTA in a prospective, randomized, double-blind, placebo-controlled multicenter trial.
  
  
  METHODS
  A total of 370 patients scheduled for CTA, with sinus rhythm ≥70 beats/min but ineligible for intravenous beta-blockers, were randomized to an intravenous bolus of 10 mg (HR, 70-79 beats/min) or 15 mg (HR ≥80 beats/min) ivabradine or placebo. Primary end point was the proportion of patients achieving HR ≤65 beats/min at the initiation of coronary CTA (Ta).
  
  
  RESULTS
  Baseline HR was 79 ± 8.5 beats/min. At Ta, HR ≤65 beats/min was achieved in 55% of the ivabradine group vs. 23% for placebo (P < .0001) and in 68% vs. 16% 1-hour after bolus administration (P < .0001). Contrast-enhanced coronary CTA was performed in 87% of the ivabradine group vs. 65% for placebo (P < .0001). Mean HR at Ta was 67 ± 10 beats/min for ivabradine vs. 75 ± 10 beats/min for placebo (P < .0001). Procedural convenience was scored better with ivabradine ("good" or "very good" in 79% vs 63% for placebo; P = .0005). The effective radiation dose of contrast-enhanced CTA was 13 ± 7 mSv for ivabradine vs. 16 ± 7 mSv for placebo (P < .05). Ivabradine was well tolerated.
  
  
  CONCLUSIONS
  An intravenous bolus of ivabradine achieves rapid, safe, and sustained HR lowering during coronary CTA, increasing procedural convenience and reducing radiation exposure vs placebo.
authors.affiliation: Department of Radiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands. Electronic address: filippocademartiri@gmail.com.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.affiliation: Department of Cardiovascular Magnetic Resonance, Institut Cardiovasculaire Paris Sud, Hospital Jacques Cartier, Generale de Santé, Massy, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Garot
authors.affiliation: 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Tendera
authors.affiliation: Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D001552:Benzazepines / Q000008:administration & dosage*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004311:Double-Blind Method; D005060:Europe; D005260:Female; D006339:Heart Rate / Q000528:radiation effects*; D006801:Humans; D007275:Injections, Intravenous; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D015990:Placebo Effect; D011292:Premedication / Q000379:methods*; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine
keywords: Computed tomography; Coronary CT angiography; Heart rate control; Ivabradine