Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Feb 23;77(7):861-871.
doi: 10.1016/j.jacc.2020.12.029.

Randomized Trial of Ivabradine in Patients With Hyperadrenergic Postural Orthostatic Tachycardia Syndrome

Pam R Taub  1 , Adena Zadourian  2 , Hannah C Lo  3 , Cameron K Ormiston  3 , Shahrokh Golshan  4 , Jonathan C Hsu  5
Affiliations
Free article
Randomized Controlled Trial

Randomized Trial of Ivabradine in Patients With Hyperadrenergic Postural Orthostatic Tachycardia Syndrome

Pam R Taub et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Postural orthostatic tachycardia syndrome (POTS) is a complex, multifaceted disorder that impairs functional status and quality of life. Current pharmacological treatments are limited.

Objectives: This study investigated the effect of ivabradine (selective blocker of the Ifunny channel in the sinoatrial node) on heart rate, quality of life (QOL), and plasma norepinephrine (NE) levels in patients with hyperadrenergic POTS defined by plasma NE >600 pg/ml and abnormal tilt table test.

Methods: In total, 22 patients with hyperadrenergic POTS as the predominant subtype completed a randomized, double-blinded, placebo-controlled, crossover trial with ivabradine. Patients were randomized to start either ivabradine or placebo for 1 month, and then were crossed over to the other treatment for 1 month. Heart rate, QOL, and plasma NE levels were measured at baseline and at the end of each treatment month.

Results: The average age was 33.9 ± 11.7 years, 95.5% were women (n = 21), and 86.4% were White (n = 23). There was a significant reduction in heart rate between placebo and ivabradine (p < 0.001). Patients reported significant improvements in QOL with RAND 36-Item Health Survey 1.0 for physical functioning (p = 0.008) and social functioning (p = 0.021). There was a strong trend in reduction of NE levels upon standing with ivabradine (p = 0.056). Patients did not experience any significant side-effects, such as bradycardia or hypotension, with ivabradine.

Conclusion: Ivabradine is safe and effective in significantly improving heart rate and QOL in patients with hyperadrenergic POTS as the predominant subtype.

Keywords: hyperadrenergic; ivabradine; postural orthostatic tachycardia syndrome; randomized cross-over trial; tachycardia.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures A grant from Amgen was received to conduct this investigator-initiated clinical trial. No financial support was received in the writing of this paper. Dr. Taub has served as a consultant for Amgen, Bayer, Esperion, Boehringer Ingelheim, Novo Nordisk, and Sanofi; is a shareholder in Epirium Bio; and has received research grants from the NIH (R01 DK118278-01 and R01 HL136407), the American Heart Association (SDG #15SDG2233005), and the Department of Homeland Security/FEMA (EMW-2016-FP-00788). Dr. Hsu has served as a consultant for Medtronic, Abbott, Boston Scientific, Biotronik, Biosense Webster, Zoll Medical, Pfizer, Bristol Myers Squibb, and Janssen Pharmaceuticals; has received research grants from Biosense Webster and Biotronik; and is a shareholder in Acutus Medical and Vektor Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Publication types

LinkOut - more resources