Arrhythmias & electrophysiology
Ivabradine for controlling heart rate in permanent atrial fibrillation: A translational clinical trial
Authors' conclusion
Ivabradine produced a moderate rate reduction in patients with permanent atrial fibrillation. The inhibition of funny current in the atrioventricular node seems to be the main mechanism responsible for this reduction. Compared with digoxin, ivabradine was less effective, was better tolerated, and had a similar rate of serious adverse events.
Study context
- Population
- Uncontrolled permanent AF despite β-blocker or calcium channel blocker treatment
- Participants
- 35 vs 33
- Comparison
- Ivabradine vs digoxin
- Ivabradinen = 35
- Digoxinn = 33reference
Methodological detailsmulticentre, open-label, phase III, non-inferiority, with in vitro patch-clamp and simulation studies
- Multicentre
- Open-label
- Phase III
- Non-inferiority
- With in vitro patch-clamp and simulation studies
Primary result
As reported in the abstract
Mean daytime heart rate decrease
| Group | Value | Relative change | P vs baseline |
|---|---|---|---|
| Ivabradine | mean decrease 11.6 beats/min | −11.5% | P = .02 |
| Digoxin | mean decrease 19.6 beats/min | −20.6% | P < .001 |
Value
Ivabradinemean decrease 11.6 beats/min
Digoxinmean decrease 19.6 beats/min
Relative change
Ivabradine−11.5%
Digoxin−20.6%
P vs baseline
IvabradineP = .02
DigoxinP < .001
- Ivabradine vs Digoxin: P = 0.97 — noninferiority margin of efficacy not met (Z = −1.95)
Further findings
In vitro: inhibition by ivabradine 1 μM
- Funny current inhibited
- 28.9%
- Rapidly activating delayed rectifier potassium current inhibited
- 22.8%
- Significance
- P < 0.05
- Sodium and L-type calcium currents reduced only at 10 μM
Simulation: modeled human AV node action potential firing frequency
- Firing frequency slowed
- 10.6%
- Minimal prolongation of ventricular action potential
Safety
Primary safety end point
P = 0.10
Original publication
Ivabradine for controlling heart rate in permanent atrial fibrillation: A translational clinical trial. Heart Rhythm. Published June 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →