Inappropriate sinus tachycardia-symptom and heart rate reduction with ivabradine: a pooled analysis of prospective studies
Abstract
Background Inappropriate sinus tachycardia (IST) is debilitating despite available treatment. Off-label use of ivabradine for IST prompted this systematic analysis of existing data quality and sample size estimates for adequately powered studies.Objective To determine clinical efficacy of ivabradine in IST from pooled prospective studies.Methods Analysis included ivabradine studies for IST participants without structural heart disease and with follow-up of ≥2 weeks. Heart rate and symptom reduction with ivabradine were estimated based on results of subjective change in symptoms assessed by various data instruments used in each study. Studies were assessed for quality using validated checklists. Sample sizes were calculated based on the magnitude of symptom reduction encountered after treatment with ivabradine.Results Nine studies met criteria, culminating in 145 patients pooled. Most patients were women (≥70%). Studies were small and not adequately powered, and all reported a decrease in maximum or mean resting heart rate or both, with complete or considerable amelioration of symptoms with ivabradine. Most studies had moderate quality with excellent consistency of study quality and narrow limits of agreement between the quality checklists. Sample size estimates for adequately powered studies with various placebo effects and comparisons with β-blockade are reported.Conclusions Ivabradine effectively reduces heart rate and symptoms in IST, but no study was adequately powered to account for the expected placebo effect on symptoms. A multicenter, randomized, placebo-controlled, active, comparative study with a β-blocker is needed for confirmation. This is especially relevant given the ivabradine's potential teratogenic effect, as many IST patients are females of childbearing potential.
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Properly dosed exercise training can be an effective non-pharmacologic therapeutic intervention for reversing severe muscle disuse atrophy and restoring normal exercise cardiac rate and rhythm caused by continuous bedrest in otherwise healthy adults.
“Properly dosed exercise training can be an effective non-pharmacologic therapeutic intervention for reversing severe muscle disuse atrophy and restoring normal exercise cardiac rate and rhythm caused by a continuous period of bedrest in otherwise healthy adults192–194.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [194]
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- Authors
- Mathew, S. T., Po, S. S., & Thadani, U.
- Affiliations
- Oklahoma City VA Medical Center (US)
- University of Oklahoma Health Sciences Center (US)
- Corresponding author
- Mathew, Sunil T.
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 15
- Issue
- 2
- Pages
- 240-247
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2761996404
- Cited by
- 29
- References
- 36
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 1 · 2023: 2 · 2022: 6 · 2021: 7 · 2020: 1 · 2019: 3 · 2018: 3
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- inappropriate sinus tachycardia, ivabradine, heart rate reduction, symptom relief, off-label drug use, study quality assessment, sample size determination, placebo effect, beta-blockers, teratogenicity, women of reproductive age
- MeSH terms
- Ivabradine, Benzazepines, Cardiovascular Agents, Heart Rate, Humans, Prospective Studies, Tachycardia, Sinus, Treatment Outcome
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