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Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature

Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by symptoms such as palpitations, dyspnea, chest discomfort, and lightheadedness affecting various systems. The pathophysiology of POTS is not completely understood due to a variety of symptoms showing that the d...

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Autores principales: Tahir, Faryal, Bin Arif, Taha, Majid, Zainab, Ahmed, Jawad, Khalid, Muhammad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255540/
https://www.ncbi.nlm.nih.gov/pubmed/32489723
http://dx.doi.org/10.7759/cureus.7868
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author Tahir, Faryal
Bin Arif, Taha
Majid, Zainab
Ahmed, Jawad
Khalid, Muhammad
author_facet Tahir, Faryal
Bin Arif, Taha
Majid, Zainab
Ahmed, Jawad
Khalid, Muhammad
author_sort Tahir, Faryal
collection PubMed
description Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by symptoms such as palpitations, dyspnea, chest discomfort, and lightheadedness affecting various systems. The pathophysiology of POTS is not completely understood due to a variety of symptoms showing that the disease is multifactorial. There is no approved uniform management strategy for POTS and hence, no drug has been approved by the United States (US) Food and Drug Administration (FDA) for it. Ivabradine is an FDA-approved drug for stable symptomatic heart failure (HF) and patients with an ejection fraction (EF) of ≤35%. Previous studies have depicted improvement in symptoms of POTS with the use of ivabradine. It is a selective inhibitor of funny sodium channels (I(f)) in the sinoatrial (SA) node cells resulting in the prolongation of the slow diastolic depolarization (phase IV) and reduction in the heart rate (HR). Although beta-adrenoceptor blockers are commonly used to lower HR in patients with POTS, they are less ideal due to numerous adverse effects. This review aims to provide a comprehensive and up-to-date picture of all the studies and case reports that utilized ivabradine for the treatment of POTS along with a precise overview of epidemiology, pathophysiology, and types of POTS. To conclude, we recommend further research on the effectiveness of ivabradine in patients who experience symptoms of POTS. Other than stable chronic angina pectoris, its application in this setting has been proven to be effective and safe. Further evaluation by means of randomized control trials is required to encourage use of this HR-lowering agent in common disorders other than HF and stable angina, i.e. POTS.
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spelling pubmed-72555402020-06-01 Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature Tahir, Faryal Bin Arif, Taha Majid, Zainab Ahmed, Jawad Khalid, Muhammad Cureus Cardiology Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by symptoms such as palpitations, dyspnea, chest discomfort, and lightheadedness affecting various systems. The pathophysiology of POTS is not completely understood due to a variety of symptoms showing that the disease is multifactorial. There is no approved uniform management strategy for POTS and hence, no drug has been approved by the United States (US) Food and Drug Administration (FDA) for it. Ivabradine is an FDA-approved drug for stable symptomatic heart failure (HF) and patients with an ejection fraction (EF) of ≤35%. Previous studies have depicted improvement in symptoms of POTS with the use of ivabradine. It is a selective inhibitor of funny sodium channels (I(f)) in the sinoatrial (SA) node cells resulting in the prolongation of the slow diastolic depolarization (phase IV) and reduction in the heart rate (HR). Although beta-adrenoceptor blockers are commonly used to lower HR in patients with POTS, they are less ideal due to numerous adverse effects. This review aims to provide a comprehensive and up-to-date picture of all the studies and case reports that utilized ivabradine for the treatment of POTS along with a precise overview of epidemiology, pathophysiology, and types of POTS. To conclude, we recommend further research on the effectiveness of ivabradine in patients who experience symptoms of POTS. Other than stable chronic angina pectoris, its application in this setting has been proven to be effective and safe. Further evaluation by means of randomized control trials is required to encourage use of this HR-lowering agent in common disorders other than HF and stable angina, i.e. POTS. Cureus 2020-04-28 /pmc/articles/PMC7255540/ /pubmed/32489723 http://dx.doi.org/10.7759/cureus.7868 Text en Copyright © 2020, Tahir et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Tahir, Faryal
Bin Arif, Taha
Majid, Zainab
Ahmed, Jawad
Khalid, Muhammad
Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature
title Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature
title_full Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature
title_fullStr Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature
title_full_unstemmed Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature
title_short Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature
title_sort ivabradine in postural orthostatic tachycardia syndrome: a review of the literature
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255540/
https://www.ncbi.nlm.nih.gov/pubmed/32489723
http://dx.doi.org/10.7759/cureus.7868
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