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Ivabradine in children with postural orthostatic tachycardia syndrome: a retrospective study

Published online by Cambridge University Press:  05 June 2020

Arooge Towheed Open the ORCID record for Arooge Towheed [Opens in a new window] ,
Zeid Nesheiwat ,
Muhammad A Mangi ,
Beverly Karabin  and
Blair P Grubb
Arooge Towheed*
Affiliation:
Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA
Zeid Nesheiwat
Affiliation:
Department of Internal Medicine, University of Toledo, Toledo, OH, USA
Muhammad A Mangi
Affiliation:
Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA
Beverly Karabin
Affiliation:
Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA
Blair P Grubb
Affiliation:
Department of Cardiovascular Disease, University of Toledo, Toledo, OH, USA
*
Author for correspondence: Arooge Towheed, Division of Cardiovascular Diseases, The University of Toledo, 3000 Arlington Avenue, 43614, MS 1118, Toledo, OH, USA. Tel: +1 419 383 1245; Fax: +1 419 383 3041. E-mail: aroogetowheed@gmail.com
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Abstract

Background:

Ivabradine is a unique medication that reduces the intrinsic heart rate by specifically blocking the inward funny current that controls the pacemaker activity of the sinus node. We conducted a retrospective cohort study to assess the efficacy of ivabradine in children suffering from postural orthostatic tachycardia syndrome.

Methods:

A chart review was conducted of patients less than 18 years of age who were diagnosed with postural orthostatic tachycardia syndrome who had received ivabradine as treatment from January 2015 to February 2019 at our institution. Twenty-seven patients (25 females, 92.5%) were identified for the study. The outcomes which were assessed included a change in the severity and frequency of symptoms, heart rate, and blood pressure before and after starting ivabradine.

Results:

There was an improvement in the symptoms of 18 (67%) out of 27 patients. The most notable symptom affected was syncope/presyncope with a reduction in 90%, followed by lightheadedness (85%) and fatigue (81%). The vital signs of the patients showed an overall significant lowering of the heart rate during sitting (89.7 ± 17.9 versus 73.2 ± 12.1; p-value <0.05) and standing (100.5 ± 18.1 versus 80.9 ± 10.1; p-value <0.05) without a significant change in the blood pressure. Two patients had visual disturbances (luminous phenomena). Severe bradycardia and excessive flushing were seen in two patients, respectively. Another one patient reported joint pain and fatigue.

Conclusion:

This study indicates that 67% of children treated with ivabradine report an improvement in symptoms.

Keywords

Orthostatic intolerancemedicationschildren
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 975 - 979
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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