Cover

Heart Rate Slowing by If Current Inhibition

Editor(s): Camm A.J. (London) 
Tendera M. (Katowice) 
Table of Contents
Vol. 43, No. , 2006
Section title: Paper
Camm J, Tendera M (eds): Heart Rate Slowing by If Current Inhibition. Adv Cardiol. Basel, Karger, 2006, vol 43, pp 65-78
(DOI:10.1159/000095429)

Heart Rate Slowing versus Other Pharmacological Antianginal Strategies

Results of Comparative Studies

Diaz A. · Tardif J.
Montreal Heart Institute, Montreal, Canada

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Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 8/24/2006
Cover Date: 2006

Number of Print Pages: 14
Number of Figures: 0
Number of Tables: 0

ISBN: 978-3-8055-8160-8 (Print)
eISBN: 978-3-318-01381-8 (Online)

Abstract

Relieving the symptoms of angina and improving the quality of life and functional status are important objectives in the management of patients with chronic stable angina. A high heart rate induces or exacerbates myocardial ischemia and angina because it both increases oxygen demand and decreases myocardial perfusion. Β-Blockers are effective at reducing anginal symptoms largely by decreasing heart rate. Physician use and patient compliance may be limited by the side effects of Β-blockers which include fatigue, depression and sexual dysfunction. Heart rate reduction can also be obtained by the calcium antagonists verapamil and diltiazem and by the new selective heart-rate-reducing agent ivabradine. Ivabradine (Procoralan) is a selective and specific If inhibitor that acts on one of the most important ionic currents for the regulation of the pacemaker activity of sinoatrial node cells. Ivabradine has demonstrated dosedependent anti-ischemic and antianginal effects in a placebo-controlled study. The INITIATIVE trial is a large multicenter trial in which 939 patients with stable angina were randomized to ivabradine or atenolol. The noninferiority of ivabradine was shown in the INITIATIVE trial at all doses and for all criteria including time to limiting angina. The number of angina attacks per week was decreased by two thirds with both ivabradine and atenolol. In another trial of 1,195 patients, time to 1mm ST segment depression was increased by 45 s with ivabradine 7.5 mg b.i.d. and by 40 s with amlodipine 10 mg daily. Unlike Β-blockers, ivabradine is devoid of intrinsic negative inotropic effects and does not affect coronary vasomotion. A whole range of patients with angina may benefit from exclusive heart rate reduction with ivabradine, including those with contraindications or intolerance to the use of Β-blockers and patients that are insufficiently controlled by Β-blockers or calcium channel blockers.


Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 8/24/2006
Cover Date: 2006

Number of Print Pages: 14
Number of Figures: 0
Number of Tables: 0

ISBN: 978-3-8055-8160-8 (Print)
eISBN: 978-3-318-01381-8 (Online)


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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