Ivabradine

How symptomatic are you? How high is your heart rate?

by Gemita - 2023-03-31 05:00:31

Grant, I do not know how high your heart rates are right now or how frequently you have episodes of IST.  Uncontrolled tachycardia can clearly cause adverse symptoms, so your EP is perhaps wanting to try this med first before proceeding to more invasive treatments, like an ablation which can be risky too as you already know. 

I believe several members are already using Ivabradine with success (or about to try this med for their IST).  My sister is actually taking it for her IST and heart failure along with several other meds.  Her ejection fraction on a combination of heart failure meds has vastly improved, without troublesome side effects so it is difficult to know which particular med is making the difference.

All I can advise is to ask yourself:

Is my IST frequent and causing symptoms to warrant trying a new medication, a medication that may or may not help?  In other words, how symptomatic are you?  Troublesome symptoms warrant treating.  What is your heart rate during IST episodes and what other meds have you tried to control your heart rate?  With any arrhythmia, rate control like a beta blocker or calcium channel blocker is always tried first and are generally safer options compared with an anti arrhythmic medication, at least this is what I was told and this seems reasonable to me.

I see Ivabradine is a new generation anti arrhythmic used to treat sinus tachycardia, but as with all anti arrhythmic meds, the potential is always there for the medication to become “pro arrhythmic”.  It seems clinical evidence on Ivabradine is still limited, so it is difficult to know how best to advise you although if you have confidence in your EP, it should help with your decision making.  You have your pacemaker already in place to help protect you from any long pausing or heart rate falls which could be dangerous without a pacemaker.  My advice, if you are symptomatic, is to try Ivabradine for a short period to see whether it helps and then perhaps review the situation with your EP.

All arrhythmia treatments are unfortunately trial and error for most of us.  All meds come with certain warnings and reading those warnings scare me too sometimes, but so does uncontrolled tachycardia which can lead to cardiomyopathy which in turn can lead to worsening arrhythmias, so a vicious circle.  Control of your IST seems like a sensible first step if you are truly symptomatic?  Please let us know what you decide to do and I wish you lots of luck with Ivabradine

Symptomatic

by Grantbibby98 - 2023-03-31 10:37:44

Thanks Gemita, you always provide thorough and excellent responses. I think taking the meds is benificial as I've become more symptomatic with chest pains and tightness, also suffering from insomnia due to the heart rate and anxiety keeping me up. I've started he meds this morning and taking one later on. I'll use this thread as a way of positing updates. I'm also instructed to drink at least 3 litres of water, at least 5 minutes of diaphragmic breathing exercises and increase salt intake. My heart rate can reach 130 on the bisoprolol laying down in an episode. Whilst not dangerously high it's not a nice feeling and will most likely get worse, this was whilst on the beta blockers too. I'm going to give these meds my best shot and hopefully don't suffer from the faster heart rate side effect. I've only ever heard good stories regarding this medication so hopefully I can join that club and eventually wean off them and be normal! Thanks again for the response it's always a pleasure to read them.

Grant

Progress

by Grantbibby98 - 2023-04-04 08:50:24

Hi Gemita,

I started the meds and have now been on them for 5 days, 2.5mg day and night. I had an episode last night of breakthrough cardia but I've been made aware that it's sinus rhythm. I've got the pacemaker technicians to drop my heart rate down to 50 minimum and also queried why my AV search has been turnt off. I was in sinus rhythm at my appointment but it doesn't come through due to this setting, frustrating, talking to my EP tonight. I should be 78% paced but instead I'm 100%! In terms of meds I think I may need a higher dosage, more info to come.

Grant

Stay confident

by Gemita - 2023-04-05 07:02:57

Dear Grant,

I have just picked up on your update.  You sound as though you have good access to your pacemaker data which is something I am still trying to achieve, at least full access to all my settings.

I think it would be wise to ask about your settings, to make sure that these are set appropriately for you and are not perhaps fuelling the IST?  I know sub-optimal setting(s) can lead to problems for some of us.  I am not suggesting yours are set wrongly since you clearly have had, and still have, arrhythmias which complicate the pacing picture, but it would be worth letting your trusted EP/cardiologist know that you are concerned and would like to “review” your settings, in particular your AV settings. 

When you say you should be 78% paced instead of 100%, I would say not so, since pacing percentages are changing all the time and if you need to be paced, you need to be paced Grant, especially if your congenital heart block has progressed?  (Another question for your EP)?  

I would ask to go through some of your settings and have them explained to you, particularly whether the 100% ventricular pacing is appropriate?  Is this because your condition has changed (you have developed complete heart block), or might your pacemaker settings be causing inappropriate ventricular pacing?   I don’t think however, it would be wise to try to reduce the % time you are paced in the ventricles if you have a high degree of heart block, since this would perhaps indicate you need "more" pacing support.

With regards to the Ivabradine, it is still early days, so you might want to wait a bit longer before increasing your dosage.  In any event I tend to try not to take ever increasing dosages of rate control/anti arrhythmic meds.  It is really all about “controlling” your arrhythmia episodes, not “eradicating” them completely Grant.  Perhaps “eradication” is not something that we arrhythmia sufferers can ever hope to completely achieve as you will know from your failed ablations.  I have achieved good control over all my arrhythmias and I am doing this as gently as possible.  I was heading for a pulmonary vein isolation and or AV Node ablation at one time, but cancelled both thankfully when my arrhythmias were better controlled.

If your symptoms however are still troublesome, then that is a different matter and you should work with your doctors to see what more can be done.  And look at other triggers as well, including gastric ones, thyroid, infection, anemia, dehydration, electrolytes.  It is a combination of treatments Grant that might be necessary.  I am on lifelong PPI for gastric reflux for example, despite surgical treatment for same.  When I miss a PPI dose (Lansoprazole 30mg) I usually suffer a night time episode of Afib, so I can clearly correlate the arrhythmia to a gastric event.