Ivabradine in treatment of sinus tachycardia mediated vasovagal syncope

作者：Sutton Richard^*; Salukhe Tushar V; Franzen Mcmanus Ann Christine; Collins Andrea; Lim Phang Boon; Francis Darrel P

来源：Europace, 2014, 16(2): 284-288.

DOI：10.1093/europace/eut226

• Vasovagal syncope
• Postural orthostatic tachycardia syndrome
• Ivabradine
• Tilt testing
• Syncope Clinic

Ivabradine, an I(f) current blocker, has shown promising results in treatment of postural orthostatic tachycardia syndrome (POTS). There is a subgroup of vasovagal syncope (VVS) patients, who demonstrate sinus tachycardia before collapse on tilt testing mimicking some features of POTS. These patients may also respond to ivabradine therapy.
University Hospital Syncope Clinic where ivabradine was prescribed in a prospective fashion on humanitarian grounds between October 2008 and December 2011.
Twenty-five patients of mean age 33years presenting syncope in all and palpitation in 23, duration 9years underwent tilt testing with reproduction of usual symptoms including tachycardia preceding collapse. Ivabradine was prescribed in doses of 520 mg/day, mean 10.7 mg, as once or twice daily medication. The response to treatment was classified as deterioration in none, no change in 5, improvement in 10, and symptoms abolished in 8 patients. Side effects were minimal; one patient required discontinuation.
In this pilot study of ivabradine, in patients with VVS, of patients who demonstrated sinus tachycardia before collapse on tilt, 72 reported a marked benefit or complete resolution of symptoms. The drug was well tolerated. A randomized controlled trial against placebo is justified.

• 出版日期2014-2