Pure heart rate reduction with ivabradine

The importance of heart rate reduction in relieving cardiac ischemia is well documented¹ and suggests a strong possibility of reduction in cardiovascular morbidity and mortality.² The recent European guidelines on cardiovascular disease prevention also mention heart rate reduction in stable angina patients and I_f inhibition as one way of achieving this.³

Ivabradine provides pure heart rate reduction. It is the first specific and selective I_f current inhibitor in the sinus node^4-8 available for clinical use. Ivabradine slows heart rate by decreasing the velocity of diastolic depolarization (ie, by reducing the ‘steepness’ of the I_f current slope of diastolic depolarization^9,10) in sinus node cells (Figure 1).

Thus ivabradine is the first treatment to reduce heart rate exclusively while fully preserving myocardial contractility and relaxation, atrioventricular conduction, ventricular repolarization, as well as blood pressure.
Ivabradine also permits coronary vasodilatation during exercise. It preserves endothelium-mediated vasodilatation at rest and during exercise vs. atenolol (α-adrenoceptor-mediated coronary vasoconstriction).

These effects lead to increased coronary blood flow¹¹.
Thus ivabradine not only - reduces myocardial oxygen demand
                                    - but also maximizes oxygen supply

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