Harnessing Your Heartbeat with Ivabradine
Living with dysautonomia is like having an unpredictable battery – you never know when you're going to run out of juice. Imagine you're about to stand up after sitting for a while, and suddenly, it feels like you might faint. That's a regular thing for me because my body struggles with blood pressure control. And fatigue? It's like someone pulled the plug on me, even if I've had a full night's sleep. I have to plan my days around these energy crashes and dizzy spells, and sometimes I have to bail on plans last minute – it's like my body's the boss of my schedule, not me.
Heartbeat Regulation with Ivabradine
Dysautonomia, a complex condition characterized by the autonomic nervous system's dysfunction, can manifest in various challenging symptoms, including rapid heartbeat and palpitations. Ivabradine has emerged as a promising treatment option for managing these cardiovascular symptoms associated with dysautonomia.
Many patients with Long COVID or ME/CFS also experience autonomic dysfunction and symptoms of dysautonomia. Treatment with ivabradine can often provide symptom improvement and a better quality of life.
Symptoms of Dysautonomia
Dysautonomia patients often struggle with an array of symptoms, but one of the most common and distressing is tachycardia, an abnormally fast heart rate. Ivabradine specifically targets this symptom by reducing the heart rate, which can:
Alleviate palpitations
Decrease fatigue
Improve exercise tolerance
Enhance the overall quality of life
The Science Behind Ivabradine
Ivabradine is FDA-approved for the treatment of stable symptomatic heart failure due to dilated cardiomyopathy. Unlike other heart medications that affect blood pressure or contractility, ivabradine's action is heart rate-specific, making it an option for treating tachycardia commonly seen with postural orthostatic tachycardia syndrome (POTS). Here is how ivabradine works.
Selective Inhibition
Ivabradine selectively inhibits the Lf (“funny”) current in the sinoatrial node, the heart's natural pacemaker. This Lf current plays a crucial role in the initiation and regulation of the heartbeats.
Heart Rate Reduction
By inhibiting the Lf current, ivabradine slows the heart’s internal pacemaker speed, thereby reducing heart rate in a precise and controlled manner with minimal effects on blood pressure.
Improved Cardiac Efficiency
A lower heart rate allows the heart to fill up with more blood between beats so that more blood is pumped into the body with every heartbeat. Ivabradine improves cardiac output and efficiency, leading to better delivery of oxygen-rich blood to the body.
Ivabradine's Role in Treating Dysautonomia-Related Tachycardia
For those with dysautonomia, ivabradine can be particularly beneficial in managing symptoms like:
Inappropriate sinus tachycardia (IST)
Postural orthostatic tachycardia syndrome (POTS)
Other forms of tachycardia associated with dysautonomia
Safety and Efficacy
Clinical experience and studies suggest that ivabradine is effective in reducing heart rate and improving symptoms in patients with dysautonomia, though individual responses can vary. Ivabradine is generally well-tolerated, with a safety profile that makes it suitable for long-term use in managing chronic conditions. However, patients should be aware of potential side effects that can include:
Phosphenes (visual brightness or light flashes)
Bradycardia (abnormally slow heart rate)
Palpitations (if the heart rate drops too low)
Elevated blood pressure in some cases
Dizziness or lightheadedness
Headache
Fatigue
Nausea
Visual disturbances (other than phosphenes)
Shortness of breath (dyspnea)
The Path Forward
Whether you have been living with dysautonomia for years or have only recently received a diagnosis (possibly in connection with Long COVID or ME/CFS), ivabradine is a medication that may be able to stop your world from spinning and improve your quality of life. Ivabradine may help address many of the symptoms, such as fatigue and dizziness, that you live with every day. If you are interested in exploring ivabradine as a treatment option, consult with your healthcare provider or visit RTHM Direct to learn how this treatment option can help combat autonomic dysfunction and get you back on the path to better health.
Follow the Science
Ivabradine is a selective Lf channel blocker designed for lowering heart rate in order to treat conditions like heart failure (on-label) and is used off-label for many conditions, including postural orthostatic tachycardia syndrome (POTS). Several studies show that ivabradine can improve symptoms in POTS patients by lowering their heart rate without affecting blood pressure. Some key studies include:
Abdelnabi, M., Saleh, Y., Ahmed, A., Benjanuwattra, J., Leelaviwat, N., & Almaghraby, A. (2023). Ivabradine effects on COVID-19-associated postural orthostatic tachycardia syndrome: A single center prospective study. American Journal of Cardiovascular Disease, 13(3), 162-167. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10352820/
The COVIVA Study Comparative Cohort Study of Post-Acute Covid-19 Infection with a Nested, Randomized Controlled Trial of Ivabradine for Those With Postural Orthostatic Tachycardia Syndrome This is a pre-print - David Saunders, Thomas B. Arnold, Jason M. Lavender, Daoqin Bi, Karl Alcover, Lydia D. Hellwig, Sahar T Leazer, Roshila Mohammed, Bethelhem Markos, Kanchana Perera, Dutchabong Shaw, Priscilla Kobi, Martin Evans, Autumn Mains, Marian Tanofsky-Kraff, Emilie Goguet, Edward Mitre, Kathleen P Pratt, Clifton L Dalgard, Mark C Haigney medRxiv 2023.04.25.23289110; doi: https://doi.org/10.1101/2023.04.25.23289110
Tahir, F., Arif, T. B., Majid, Z., Ahmed, J., & Khalid, M. (2020). Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature. Cureus, 12(4). https://doi.org/10.7759/cureus.7868
Ruzieh, M., Sirianni, N., Ammari, Z., Dasa, O., Alhazmi, L., Karabin, B., & Grubb, B. (2017). Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience. Pacing and Clinical Electrophysiology, 40(11), 1242-1245. https://doi.org/10.1111/pace.13182
Abdelnabi, M., Ahmed, A., Benjanuwattra, J., Saleh, Y., Leelaviwat, N., & Almaghraby, A. (2023). IVABRADINE EFFECTS ON COVID-19 INDUCED POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME. Journal of the American College of Cardiology, 81(8), 56. https://doi.org/10.1016/S0735-1097(23)00500-4
Oliphant CS, Owens RE, Bolorunduro OB, Jha SK. Ivabradine: A Review of Labeled and Off-Label Uses. Am J Cardiovasc Drugs. 2016;16(5):337-347. doi:10.1007/s40256-016-0178-z
NIH opens long COVID trials to evaluate treatments for autonomic nervous system dysfunction. (2024, March 12). National Institutes of Health (NIH). https://www.nih.gov/news-events/news-releases/nih-opens-long-covid-trials-evaluate-treatments-autonomic-nervous-system-dysfunction
