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Effects of Ivabradine on 6-Minute Walk Test and Quality of Life in Patients With Previously Implanted CRT-D
  1. Ismail Ates, MD*,
  2. Asuman H. Yavuz, MD,
  3. Mehmet Doğru, MD*,
  4. Ahmet Genç, MD*,
  5. Şeref Ulucan, MD,
  6. Metin Sarıkaya, MD§,
  7. Ramazan Çetinkaya, MD§,
  8. Ahmet Keser, MD,
  9. Mahmut Akpek, MD,
  10. Mehmet G. Kaya, MD
  1. From the Departments of *Cardiology and †Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey; ‡Department of Cardiology, School of Medicine, Mevlana University, Konya, Turkey; §Department of Nephrology, Antalya Research and Education Hospital, Antalya, Turkey; and ∥Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey.
  1. Received August 22, 2012, and in revised form January 21, 2013.
  2. Accepted for publication April 6, 2013.
  3. Reprints: Ismail Ates, MD, Department of Cardiology, Medline Hospital, Antalya, Turkey. E-mail: drates07{at}gmail.com.
  4. The authors do not have conflicts of interest.

Abstract

Background We aimed to evaluate clinical effects of additional heart rate control by ivabradine on life quality score and 6-minute walking test in patients with previously implanted biventricular cardiac resynchronization therapy defibrillator (CRT-D) with ischemic heart failure under regular treatment.

Methods Fifteen men and 14 women with a median age of 63 years (range, 48–79 years) were studied. Twenty-one patients were in New York Heart Association class II (8 patients were in class III), CRT-D implanted previously, and with resting heart rates greater than 70 beats per minute with sinus rhythm despite conventional medication. Patients were given 2.5- to 7.5-mg ivabradine orally twice a day, and drug dosage was titrated to decrease the patients’ average heart rate to 70 beats per minute. Before and 3 months after ivabradine treatment, all patients underwent extensive clinical, echocardiographic, and laboratory evaluation.

Results Ivabradine treatment produced dose-dependent reductions in heart rate at rest and at peak exercise (91.9 ± 6.3 to 71.7 ± 4.8 and 114.4 ± 7.6 to 96.8 ± 4.8; P = 0.001 and P = 0.001, respectively). There were also significant improvements in life quality score (52.4 ± 9.5 to 37.9±7.8; P = 0.001) and 6-minute walking distance (278.7 ± 85.8 to 373.3 ± 94.0; P = 0.001) of patients. All patients with New York Heart Association class III became class II after 3 months of ivabradine treatment.

Conclusion Heart rate reduction in a short-term period by ivabradine produced significant improvements in exercise capacity and life quality in patients with CRT-D and conventional therapy.

Key words
  • ivabradine
  • ischemic heart failure
  • quality of life

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