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Ivabradine in combination with metoprolol succinate in the treatment of inappropriate sinus tachycardia.
J Cardiovasc Pharmacol Ther. 2013 Jul; 18(4):338-44.JC

Abstract

BACKGROUND

Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or a disproportional increase in HR during exercise. β-blocker or calcium channel-blocker therapy is often noneffective or not well tolerated. The HR reduction on ivabradine is similar to β-blockers but in some patients its efficacy to resolve all IST-related symptoms is limited. The aim of the study was to assess the efficacy and safety of combining ivabradine with metoprolol succinate in patients with refractory highly symptomatic IST.

METHODS

Twenty patients (36 ± 10 years; 16 women) with IST were enrolled. All patients received metoprolol succinate 95 mg single dose during the first month of the study. After 4 weeks of treatment with metoprolol, ivabradine was administered as adjuvant therapy up to 7.5 mg twice daily. Holter monitoring and treadmill stress test were performed at baseline, after 4, and 8 weeks of the study, respectively.

RESULTS

We observed significant and similar reduction in resting HR both for metoprolol and for combined therapy compared to the baseline. The mean HR during daily activity was significantly lower on ivabradine and metoprolol compared to monotherapy with β-blocker. The combined treatment yielded a significant increase in exercise capacity as assessed by treadmill stress test. After 4 weeks of combined therapy a significant reduction in IST-related symptoms, measured by means of the European Heart Rhythm Association score, was observed.

CONCLUSION

Combining ivabradine with metoprolol is an effective and well-tolerated treatment option for IST in patients with refractory to monotherapy.

Authors+Show Affiliations

Department of Electrocardiology, Medical University, Lodz, Poland. pawel_ptaszynski@wp.plNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23426376

Citation

Ptaszynski, Pawel, et al. "Ivabradine in Combination With Metoprolol Succinate in the Treatment of Inappropriate Sinus Tachycardia." Journal of Cardiovascular Pharmacology and Therapeutics, vol. 18, no. 4, 2013, pp. 338-44.
Ptaszynski P, Kaczmarek K, Ruta J, et al. Ivabradine in combination with metoprolol succinate in the treatment of inappropriate sinus tachycardia. J Cardiovasc Pharmacol Ther. 2013;18(4):338-44.
Ptaszynski, P., Kaczmarek, K., Ruta, J., Klingenheben, T., Cygankiewicz, I., & Wranicz, J. K. (2013). Ivabradine in combination with metoprolol succinate in the treatment of inappropriate sinus tachycardia. Journal of Cardiovascular Pharmacology and Therapeutics, 18(4), 338-44. https://doi.org/10.1177/1074248413478172
Ptaszynski P, et al. Ivabradine in Combination With Metoprolol Succinate in the Treatment of Inappropriate Sinus Tachycardia. J Cardiovasc Pharmacol Ther. 2013;18(4):338-44. PubMed PMID: 23426376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ivabradine in combination with metoprolol succinate in the treatment of inappropriate sinus tachycardia. AU - Ptaszynski,Pawel, AU - Kaczmarek,Krzysztof, AU - Ruta,Jan, AU - Klingenheben,Thomas, AU - Cygankiewicz,Iwona, AU - Wranicz,Jerzy K, Y1 - 2013/02/19/ PY - 2013/2/22/entrez PY - 2013/2/22/pubmed PY - 2013/10/23/medline KW - heart rate KW - inappropriate sinus tachycardia KW - ivabradine KW - metoprolol SP - 338 EP - 44 JF - Journal of cardiovascular pharmacology and therapeutics JO - J. Cardiovasc. Pharmacol. Ther. VL - 18 IS - 4 N2 - BACKGROUND: Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or a disproportional increase in HR during exercise. β-blocker or calcium channel-blocker therapy is often noneffective or not well tolerated. The HR reduction on ivabradine is similar to β-blockers but in some patients its efficacy to resolve all IST-related symptoms is limited. The aim of the study was to assess the efficacy and safety of combining ivabradine with metoprolol succinate in patients with refractory highly symptomatic IST. METHODS: Twenty patients (36 ± 10 years; 16 women) with IST were enrolled. All patients received metoprolol succinate 95 mg single dose during the first month of the study. After 4 weeks of treatment with metoprolol, ivabradine was administered as adjuvant therapy up to 7.5 mg twice daily. Holter monitoring and treadmill stress test were performed at baseline, after 4, and 8 weeks of the study, respectively. RESULTS: We observed significant and similar reduction in resting HR both for metoprolol and for combined therapy compared to the baseline. The mean HR during daily activity was significantly lower on ivabradine and metoprolol compared to monotherapy with β-blocker. The combined treatment yielded a significant increase in exercise capacity as assessed by treadmill stress test. After 4 weeks of combined therapy a significant reduction in IST-related symptoms, measured by means of the European Heart Rhythm Association score, was observed. CONCLUSION: Combining ivabradine with metoprolol is an effective and well-tolerated treatment option for IST in patients with refractory to monotherapy. SN - 1940-4034 UR - https://www.unboundmedicine.com/medline/citation/23426376/Ivabradine_in_combination_with_metoprolol_succinate_in_the_treatment_of_inappropriate_sinus_tachycardia_ L2 - http://journals.sagepub.com/doi/full/10.1177/1074248413478172?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -