Ivabradine – Class 0 antiarrhythmic agent

Ivabradine – Class 0 antiarrhythmic agent Ivabradine is a Class 0 antiarrhythmic agent as per the Modernized Classification of Cardiac Antiarrhythmic Drugs [1]. It is a Hyperpolarization-Activated Cyclic Nucleotide-Gated (HCN) channel blocker. Ivabradine inhibits If current (funny current) responsible for diastolic depolarization, which is responsible for the automaticity of the sinus node. Hence it is a pure sinus node inhibitor. Action potential of pacemaker cells As an antiarrhythmic agent, it has been used in the treatment of inappropriate sinus tachycardia [2]. Ivabradine is used more often in heart failure, based on SHIFT trial [3] and in coronary artery disease with left ventricular dysfunction based on BEAUTIFUL trial [4]. Ivabradine can enhance the risk of atrial fibrillation. It has to be discontinued if AF develops. Moreover, it has no effect when not in sinus rhythm. Visual effects (phosphenes) have been described in trials as ivabradine can inhibit Ih retinal current which is similar to If current. QT prolongation and torsades des pointes can rarely occur due to the bradycardia induced by ivabradine. References Ming Lei, Lin Wu, Derek A Terrar, Christopher L-H Huang. Modernized Classification of Cardiac Antiarrhythmic Drugs. Circulation. 2018 Oct 23;138(17):1879-1896. Olisaemeka Achike and Harry DeAntonio. Ivabradine And Inappropriate Sinus Tachycardia: A Funny Target For An Inappropriate Disease. J Am Coll Cardiol. 2018; 71(11):Supplement. DOI: 10.1016/S0...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: ECG / Electrophysiology Source Type: blogs