Benezet-Mazuecos Juan, Rubio José M, Farré Jerónimo, Quiñones Miguel Á, Sanchez-Borque Pepa, Macía Ester
Department of Cardiology, Fundacion Jimenez Diaz-Capio, Universidad Autonoma de Madrid, Madrid, Spain.
Pacing Clin Electrophysiol. 2013 Jul;36(7):830-6. doi: 10.1111/pace.12118. Epub 2013 Mar 19.
Inappropriate sinus tachycardia (IST) is characterized by persistent and disproportional elevation of heart rate (HR). Ivabradine has been successfully used in some patients.
Twenty-four patients (18 women, 41 ± 13 year olds) were diagnosed with IST according to current guidelines criteria. Patients were treated with 5-7.5 mg of ivabradine twice a day. Twenty-four-hour Holter recordings and the SF-36 Health Survey were performed at 6 months to evaluate both HR control and clinical status.
Holter recordings before and after 6 months on treatment showed a significant reduction in the average maximal HR of 155 ± 18 beats/min versus 132 ± 16 beats/min, mean HR of 97 ± 6 beats/min versus 79 ± 8 beats/min (mean daytime HR of 103 ± 8 beats/min vs 84 ± 10 beats/min) and minimal HR of 58 ± 12 beats/min versus 48 ± 7 beats/min (Wilcoxon analysis, P < 0.05). The SF-36 mean score showed a significant improvement on ivabradine treatment (57 ± 23 vs 76 ± 20), with a better physical and mental status scores (56 ± 25 vs 74 ± 22 and 58 ± 24 vs 78 ± 18, respectively) (Wilcoxon analysis, P < 0.001). Mean dose of ivabradine was 5.8 ± 1.4 mg. No episodes of severe bradycardia or syncope were reported. After 1 year, patients were asked to stop treatment to reevaluate the situation. Twenty patients were on treatment and only 10 patients accepted to stop ivabradine. Only two patients (20%) remained on IST criteria.
IST patients treated with ivabradine showed both HR normalization and quality-of-life improvement maintained in the long-term follow-up. Stopping ivabradine after 1 year unexpectedly showed that HR remained in the normal limits in 80% of the patients.
不适当窦性心动过速（IST）的特征是心率（HR）持续且不成比例地升高。伊伐布雷定已在一些患者中成功使用。
根据当前指南标准，24例患者（18名女性，41±13岁）被诊断为IST。患者接受每天两次5 - 7.5毫克伊伐布雷定治疗。在6个月时进行24小时动态心电图记录和SF - 36健康调查，以评估心率控制和临床状况。
治疗6个月前后的动态心电图记录显示，平均最大心率显著降低，从155±18次/分钟降至132±16次/分钟，平均心率从97±6次/分钟降至79±8次/分钟（白天平均心率从103±8次/分钟降至84±10次/分钟），最低心率从58±12次/分钟降至48±7次/分钟（Wilcoxon分析，P < 0.05）。SF - 36平均评分显示伊伐布雷定治疗有显著改善（57±23对76±20），身体和精神状态评分更好（分别为56±25对74±22和58±24对78±18）（Wilcoxon分析，P < 0.001）。伊伐布雷定的平均剂量为5.8±1.4毫克。未报告严重心动过缓或晕厥发作。1年后，要求患者停止治疗以重新评估情况。20例患者正在接受治疗，只有10例患者接受停止伊伐布雷定治疗。只有2例患者（20%）仍符合IST标准。
接受伊伐布雷定治疗的IST患者在长期随访中显示心率正常化且生活质量得到改善。1年后停止伊伐布雷定治疗意外地发现，80%的患者心率仍保持在正常范围内。
