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Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy.
Europace. 2013 Jan; 15(1):116-21.E

Abstract

AIMS

Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or disproportional increasing HR during exercise. The treatment of IST symptoms using beta-blockers or calcium channel-blockers is often non-effective or not well tolerated. Ivabradine is a new agent inhibiting sinus node I(f) current, resulting in a decrease of HR without haemodynamic compromise.

METHODS AND RESULTS

We enrolled 20 patients (36 ± 10 years; 14 women) affected by IST and resistant to previous administered therapy by using beta-blockers or verapamil. After 4 weeks of treatment with metoprolol succinate (up to 190 mg once a day) the therapy was switched to ivabradine up to 7.5 mg twice daily. Holter monitoring and treadmill stress test were performed after 1 and 2 months following start of the study. We observed a significant reduction of resting HR both for metoprolol and for ivabradine compared with baseline (92.8 vs. 90.2 vs. 114.3 b.p.m.; P< 0.001). During daily activity there was an even larger decrease of HR on ivabradine (mean daytime HR 94.6 vs. 87.1 vs. 107.3 b.p.m.; P< 0.001). Ivabradine was very well tolerated whereas in 10 patients on metoprolol we observed hypotension or bradycardia requiring dose reduction. Significantly lower incidence of IST-related symptoms were registered on ivabradine therapy than on metoprolol. Fourteen patients (70%) treated with I(f) blocker were free of IST-related complaints.

CONCLUSIONS

Metoprolol and ivabradine exert a similar effect on resting HR in patients with IST. Ivabradine seems to be more effective to relieve symptoms during exercise or daily activity.

Authors+Show Affiliations

Department of Electrocardiology, Medical University Lodz, Regional Sterling Heart Disease Center, Sterling 1/3, 91-425, Lodz, Poland. pawel_ptaszynski@wp.plNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

22772053

Citation

Ptaszynski, Pawel, et al. "Metoprolol Succinate Vs. Ivabradine in the Treatment of Inappropriate Sinus Tachycardia in Patients Unresponsive to Previous Pharmacological Therapy." Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, vol. 15, no. 1, 2013, pp. 116-21.
Ptaszynski P, Kaczmarek K, Ruta J, et al. Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy. Europace. 2013;15(1):116-21.
Ptaszynski, P., Kaczmarek, K., Ruta, J., Klingenheben, T., & Wranicz, J. K. (2013). Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 15(1), 116-21. https://doi.org/10.1093/europace/eus204
Ptaszynski P, et al. Metoprolol Succinate Vs. Ivabradine in the Treatment of Inappropriate Sinus Tachycardia in Patients Unresponsive to Previous Pharmacological Therapy. Europace. 2013;15(1):116-21. PubMed PMID: 22772053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy. AU - Ptaszynski,Pawel, AU - Kaczmarek,Krzysztof, AU - Ruta,Jan, AU - Klingenheben,Thomas, AU - Wranicz,Jerzy K, Y1 - 2012/07/06/ PY - 2012/7/10/entrez PY - 2012/7/10/pubmed PY - 2013/6/14/medline SP - 116 EP - 21 JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JO - Europace VL - 15 IS - 1 N2 - AIMS: Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or disproportional increasing HR during exercise. The treatment of IST symptoms using beta-blockers or calcium channel-blockers is often non-effective or not well tolerated. Ivabradine is a new agent inhibiting sinus node I(f) current, resulting in a decrease of HR without haemodynamic compromise. METHODS AND RESULTS: We enrolled 20 patients (36 ± 10 years; 14 women) affected by IST and resistant to previous administered therapy by using beta-blockers or verapamil. After 4 weeks of treatment with metoprolol succinate (up to 190 mg once a day) the therapy was switched to ivabradine up to 7.5 mg twice daily. Holter monitoring and treadmill stress test were performed after 1 and 2 months following start of the study. We observed a significant reduction of resting HR both for metoprolol and for ivabradine compared with baseline (92.8 vs. 90.2 vs. 114.3 b.p.m.; P< 0.001). During daily activity there was an even larger decrease of HR on ivabradine (mean daytime HR 94.6 vs. 87.1 vs. 107.3 b.p.m.; P< 0.001). Ivabradine was very well tolerated whereas in 10 patients on metoprolol we observed hypotension or bradycardia requiring dose reduction. Significantly lower incidence of IST-related symptoms were registered on ivabradine therapy than on metoprolol. Fourteen patients (70%) treated with I(f) blocker were free of IST-related complaints. CONCLUSIONS: Metoprolol and ivabradine exert a similar effect on resting HR in patients with IST. Ivabradine seems to be more effective to relieve symptoms during exercise or daily activity. SN - 1532-2092 UR - https://www.unboundmedicine.com/medline/citation/22772053/Metoprolol_succinate_vs__ivabradine_in_the_treatment_of_inappropriate_sinus_tachycardia_in_patients_unresponsive_to_previous_pharmacological_therapy_ L2 - https://academic.oup.com/europace/article-lookup/doi/10.1093/europace/eus204 DB - PRIME DP - Unbound Medicine ER -