Novel use of ivabradine in reversible cardiomyopathy

Ivabradine may reduce the risk of tachycardia-induced cardiomyopathy when used in refractory cases of tachycardia, as was suggested by findings from a case report [1].

Paragangliomas are rare tumours that result in persistent tachycardia and hypertension. Dr Eric Torkildsen (Lehigh Valley Health Network, PA, USA) shared a case report of a 62-year-old man with a history of metastatic hereditary paraganglioma, non-ischaemic cardiomyopathy with recovered ejection fraction, and recent pericardial effusion, who presented with worsening dyspnoea and sinus tachycardia.

Echocardiographic findings included global hypokinesis, no evidence of re-accumulation of pericardial fluid, and a reduced ejection fraction of 20–25%. Angiographic findings demonstrated non-obstructive disease. Based on these findings, the patient was diagnosed with a hyperadrenergic state secondary to the hereditary paraganglioma.

Management with metoprolol succinate, phenoxybenzamine, and metyrosine failed to achieve rate control. Dr Torkildsen’s team decided to try ivabradine, a hyperpolarisation-activated, cyclic, nucleotide-gated channel blocker, which lowers heart rate [2]. Ivabradine was titrated to a dose of 7.5 mg twice daily for 6 weeks; thereafter, echocardiographic findings showed a return to normal systolic function.

In conclusion, Dr Torkildsen stressed that early recognition and management of reversible cardiomyopathy is imperative to prevent cardiac remodelling and maximise chances of a favourable recovery. Management with ivabradine led to favourable outcomes in this presented case of a 62-year old gentleman with a hereditary paraganglioma and tachycardia-induced cardiomyopathy.

1. 
   
   1. Torkildsen E. Novel use of ivabradine in the management of a catecholamine-induced cardiomyopathy secondary to a metastatic hereditary paraganglioma. ACC 2021 Scientific Session, 15–17 May.
   2. Tse S, Mazzola N. Pharmacy & Therapeutics 2015;40(12):810–814.

 

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Posted on 9 July 202129 July 2021