The Evolving Role of Ivabradine for Focal Atrial Tachycardia: A Systematic Review

TL;DR

This paper reviews how ivabradine, originally used for heart failure, is now being explored for treating focal atrial tachycardia, with promising but limited evidence.

Contribution

The paper systematically reviews ivabradine's emerging role in focal atrial tachycardia, identifying potential predictors and safety considerations.

Findings

Ivabradine shows promising efficacy and safety in treating focal atrial tachycardia based on case reports and small studies.

HCN-mediated mechanisms and specific FAT features may predict response to ivabradine.

Larger, well-designed studies are needed to confirm ivabradine's role in focal atrial tachycardia.

Abstract

Ivabradine was initially introduced for heart failure and coronary artery disease patients, with its interesting feature of heart rate reduction without reducing heart contractility or blood pressure. In recent years, however, the use of ivabradine evolved for arrhythmia, including for focal atrial tachycardia (FAT). This systematic review aims to evaluate all the existing evidence on ivabradine for focal atrial tachycardia and synthesize information on its use, including efficacy and safety.

A comprehensive literature search was conducted in three large databases: PubMed, ScienceDirect, and Scopus, following the PRISMA guidelines, using the search terms of: (ivabradine) AND (atrial tachycardia). Studies were included if they reported the use of Ivabradine for FAT in humans. Studies on atrial tachycardia outside of focal mechanisms or any other arrhythmias were excluded.

The search strategy resulted in 375 articles: 63 from PubMed, 262 from ScienceDirect, and 50 from Scopus, which subsequently resulted in 19 articles included for final review after a meticulous filtering process. The included studies were 11 case reports, 4 case series, and 4 observational studies discussing the outcome of ivabradine for focal atrial tachycardia.

Evidence from small cohorts and case reports suggests promising outcomes and a good safety profile of ivabradine for FAT, but larger, well‐designed and more robust studies are needed. Recognizing an automaticity‐driven FAT is key to considering ivabradine, especially when FAT persists despite cardioversion or standard therapy.

Overview of the evolving role of ivabradine in focal atrial tachycardia (FAT), highlighting its HCN‐mediated mechanism, features of ivabradine‐sensitive FAT, hypothesized predictors of response, special populations requiring special considerations, and potential adverse effects.

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