The role of heart rate reduction in the management of
myocardial ischemia and
chronic stable angina is pivotal. However, broad use and appropriate dosing of commonly used rate-slowing drugs is limited by their poor tolerability.
Ivabradine is a selective inhibitor of the If currents of the sinoatrial node cells. If currents activity determines the slope of the depolarization curve towards the threshold level controlling heart rate in patients with sinus rhythm.
Ivabradine, a compound of the benzocyclobutane (
S 16257), exhibits a unique specificity for the If current and has a more favorable profile of adverse reactions compared to other If inhibitors. Accordingly,
ivabradine has been used in the treatment of
stable angina, where it presented anti-anginal and anti-ischemic effects equivalent to the effects of
atenolol and
amlodipine. Clinical studies proved the efficacy of
ivabradine in patients with
stable angina, while clinical data are awaited to verify its probable value in the treatment of atrial
tachyarrhythmias and
tachycardia due to
ventricular dysfunction. Thus, the clinical value of
ivabradine, which has completed clinical development for
stable angina, is expected to exceed its role in the treatment of
myocardial ischemia. In this context,
ivabradine, promising efficacious and safe pharmacological management of heart rate, is a huge step in cardiovascular
therapeutics.