Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience
Open accessAbstract
Background: Ivabradine is a selective If channel blocker that reduces heart rate without affecting other cardiovascular functions. In case reports and case series, it was shown to improve symptoms in patients with postural tachycardia syndrome (POTS). Methodology and results: This retrospective study examined patients who were diagnosed with POTS and received ivabradine as part of their treatment. Forty‐nine patients (47 females, 95.9%) received ivabradine. The average age was 35.1 ± 10.35 years. The most common symptoms were palpitations and lightheadedness and both improved significantly, 88.4% and 76.1% response rate, respectively. A total of 38 patients reported improvement in their symptoms. In addition, ivabradine resulted in an objective decrease in sitting and standing heart rate (78.1 ± 10.7 vs 72.5 ± 7.6, P‐value: 0.01) and (107.4 ± 14.1 vs 95.1 ± 13.7, P‐value: < 0.001), respectively, with no significant change in blood pressure. The most common reported side effect was luminous phenomena/visual brightness occurring in nine patients. However, none of the patients stopped ivabradine due to side effects. Conclusion: Our study shows that ivabradine is likely to be effective in treating patients with POTS. Nearly 78% of our cohort reported a significant improvement in symptoms with no major adverse effects reported. A future randomized, placebo‐controlled trial is warranted.
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A limited number of prior studies have examined the effects of propranolol or ivabradine on POTS.
“A limited number of prior studies have examined the effects of propranolol or ivabradine on POTS.4,6,9, 10, 11, 12”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [11]
In studies of ivabradine, doses were initiated at 2.5 mg orally once or twice daily and titrated up to 10 mg twice daily based on response or side effects, with response rates between 60% and 78%.
“In these studies, doses were initiated at 2.5 mg orally once or twice daily, and titrated up to 10 mg twice daily based on response or side effects with response rates between 60% and 78% (83, 84).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [83]
Small case series have shown that ivabradine reduces upright heart rate and improves symptoms associated with orthostatic intolerance.
“Small case series have shown that ivabradine reduces upright heart rate and improves symptoms associated with orthostatic intolerance (83, 84).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [83]
Ivabradine is usually regarded as an alternative to beta-blockers in POTS.
“It is usually seen as an alternative to beta-blockers.”
From Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (2019) · cites this paper as [87]
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Self-citationSingle centre experience of ivabradine in postural orthostatic tachycardia syndrome
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Self-citationIvabradine in treatment of sinus tachycardia mediated vasovagal syncope
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Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management
Fedorowski, A. (2019) · Journal of Internal Medicine · doi:10.1111/joim.12852 · Cited by 352 · see citing works
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Postural orthostatic tachycardia syndrome: mechanisms and new therapies
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Pharmacotherapy for postural tachycardia syndrome
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- Authors
- Ruzieh, M., Sirianni, N., Ammari, Z., Dasa, O., Alhazmi, L., Karabin, B., & Grubb, B.
- Affiliations
- University of Toledo (US)
- Corresponding author
- Ruzieh, Mohammed
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 2017-09-20
- Volume
- 40
- Issue
- 11
- Pages
- 1242-1245
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W2750391391
- Cited by
- 46
- References
- 6
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 7 · 2019: 3 · 2018: 6 · 2017: 1
- FWCI
- 4.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- ivabradine, postural orthostatic tachycardia syndrome, heart rate reduction, channel blockers, symptom improvement, palpitations, lightheadedness, visual disturbances, blood pressure
- MeSH terms
- Ivabradine, Adult, Benzazepines, Cardiovascular Agents, Female, Heart Rate, Humans, Male, Retrospective Studies, Treatment Outcome, Postural Orthostatic Tachycardia Syndrome
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