Ivabradine potential for correcting myocardial electrical instability predictors in coronary heart disease

Abstract

Aim. To investigate the effects of selective, specific If inhibitor ivabradine on electrical myocardial instability predictors in patients with coronary heart disease (CHD).

Material and methods. In total, 82 patients with stable CHD, mean age 53,6±4,5 years, were examined. Complex survey included standard clinical examination, 12-lead electrocardiography (ECG), Holter ECG monitoring, stress test, echocardiography, signal-averaged (SA) ECG with late ventricular potential identification, heart rate variability (HRV) analysis, and ventricular repolarization duration assessment.

Results. Adding ivabradine to standard therapy (aspirin, statins, nitrates, ACE inhibitors) was associated with reduced angina attack incidence, increased physical stress tolerance, and decreased 24-hour myocardial ischemia. Dose-response reduction in heart rate was linked to improved diastolic myocardial function.

Conclusion. Improvement in left ventricular ischemic myocardial function was associated with improvement of electric instability parameters, with improved SA ECG, ventricular repolarization time indices and increased parasympathetic influences on autonomous balance, as assessed by HRV.