Abstract
Ivabradine is the first clinically used drug of the new class – so called sinus node inhibitors or bradins. Its only pharmacological effect is heart rate lowering.
The mechanism of it is blockade of the If channels in the sinoatrial node cells, therefore it is effective in sinus rhythm only. In this country ivabradine is registered for the treatment of stable angina pectoris in patiens who have contraindications or intolerance to betablockers or who are on betablockers in maximal tolerated daily dose and in spite of this are still symptomatic.
The combination of betablocker and ivabradine is safe, if the patient’s heart rate is ≥ 60/min. The second registered indication of ivabradine is the treatment of stabilized chronic heart failure with low ejection fraction.
Again, ivabradine can be used as an alternative to betablocker in the case of its contraindication or intolerance or in combination with betablocker, if the heart rate ≥ 75/min. In this clinical setting ivabradine significantly reduces not only rate of hospitalization for heart failure worsening, but also cardiovascular and even all-cause mortality.