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Ivabradine treatment prevents dobutamine-induced increase in heart rate in patients with acute decompensated heart failure

Cavusoglu, Yuksel; Mert, Ugur; Nadir, Aydin; Mutlu, Fezan; Morrad, Bektas; Ulus, Taner

Journal of Cardiovascular Medicine: September 2015 - Volume 16 - Issue 9 - p 603–609
doi: 10.2459/JCM.0000000000000033
Original articles: Heart failure
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Background Ivabradine is a heart rate (HR)-lowering agent acting by inhibiting the If-channel. Dobutamine does increase the HR and has some deleterious effects on myocardium. So, we aimed to evaluate whether ivabradine treatment blunts a dobutamine-induced increase in HR.

Methods The main study population consisted of 58 acute decompensated heart failure patients requiring inotropic support with left-ventricular ejection fraction below 35%, who were randomized to ivabradine (n = 29) or control (n = 29). All patients underwent Holter recording for 6 h and then dobutamine was administered at incremental doses of 5, 10 and 15 μg/kg/min, with 6-h steps. Holter recording was continued during dobutamine infusion. Ivabradine 7.5 mg was given at the initiation of dobutamine and readministered at 12 h of infusion. Also, a nonrandomized beta-blocker group with 15 patients receiving beta-blocker was included in the analysis. Control and beta-blocker groups did not receive ivabradine.

Results In the control group, mean HR gradually and significantly increased at each step of dobutamine infusion (81 ± 11, 90 ± 16, 97 ± 14 and 101 ± 16 b.p.m., respectively; P = 0.001), whereas no significant increase in HR was observed in the ivabradine group (82 ± 17, 82 ± 15, 85 ± 14 and 83 ± 12 b.p.m., respectively; P = 0.439). Mean HR was also found to significantly increase during dobutamine infusion in the beta-blocker group (75 ± 13, 82 ± 13, 86 ± 14 and 88 ± 13 b.p.m., respectively; P = 0.001). The median increase in HR from baseline was significantly higher in the control group compared to those in the ivabradine group (5 vs. 2 b.p.m.; P = 0.007 at first step, 13 vs. 5 b.p.m.; P = 0.001 at second step and 18 vs. 6 b.p.m.; P = 0.0001 at third step of dobutamine, respectively).

Conclusions Ivabradine treatment prevents dobutamine-induced increase in HR and may be useful in reducing HR-related adverse effects of dobutamine.

aCardiology Department

bBiostatistic Department, Eskisehir Osmangazi University, Eskisehir, Turkey

Correspondence to Yuksel Cavusoglu, MD, FESC, Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, 26480 Eskisehir, TurkeyTel: +90 222 239 29 79; e-mail: yukselc@ogu.edu.tr

Received 3 April, 2013

Revised 17 February, 2014

Accepted 17 February, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.