Annamaria Martino, Lupo Pier Paolo, Foresti Sara, De Ambroggi Guido, de Ruvo Ermenegildo, Sciarra Luigi, Cappato Riccardo, Calo Leonardo
Division of Cardiology, Policlinic Casilino, ASL RMB, Via Casilina 1049, Rome, Italy.
Cardiovascular, Respiratory, Nephrologic and Geriatrics Sciences Department, Umberto I Hospital, Sapienza University of Rome, Rome, Italy.
J Interv Card Electrophysiol. 2016 Jun;46(1):47-53. doi: 10.1007/s10840-015-0066-5. Epub 2015 Oct 14.
Inappropriate sinus tachycardia (IST) often causes palpitations, dyspnea, and exercise intolerance, that are generally treated with beta blockers and non-dihydropyridine calcium-channel antagonists. Ivabradine, a selective inhibitor of cardiac pacemaker If current, has recently emerged as an effective and safe alternative to conventional drugs for IST.
We performed a systematic overview of clinical studies on the therapeutic yield of ivabradine in patients with inappropriate sinus tachycardia, published in MEDLINE database from January 2000 to March 2015.
Overall, five case reports were found, all showing efficacy of ivabradine in subjects affected by IST. Eight non-randomized clinical studies demonstrated short- and medium-term safety and efficacy of ivabradine administration in IST, also in adjunction to or in comparison with metoprolol. One double-blind randomized crossover study also showed that ivabradine is superior to placebo for heart rate (HR) reduction and symptoms control in patients affected by IST.
Ivabradine is effective and safe in short- and medium-term treatment of IST. However, long-term follow-up studies and randomized studies comparing ivabradine with beta blockers are still lacking.
不适当窦性心动过速（IST）常导致心悸、呼吸困难和运动不耐受，通常用β受体阻滞剂和非二氢吡啶类钙通道拮抗剂治疗。伊伐布雷定是一种心脏起搏器If电流的选择性抑制剂，最近已成为IST传统药物的有效且安全的替代药物。
我们对2000年1月至2015年3月发表在MEDLINE数据库中关于伊伐布雷定治疗不适当窦性心动过速患者疗效的临床研究进行了系统综述。
总体而言，共发现5例病例报告，均显示伊伐布雷定对IST患者有效。8项非随机临床研究表明，伊伐布雷定在IST患者中的给药具有短期和中期安全性及有效性，与美托洛尔联合使用或比较时也是如此。一项双盲随机交叉研究还表明，伊伐布雷定在降低心率（HR）和控制症状方面优于安慰剂，适用于IST患者。
伊伐布雷定在IST的短期和中期治疗中有效且安全。然而，仍缺乏长期随访研究以及比较伊伐布雷定与β受体阻滞剂的随机研究。
