Bokhari Syed Faqeer Hussain, Mushtaq Muhammad Muaz, Mushtaq Maham, Ali Husnain, Bakht Danyal, Faizullah Muhayya, Asghar Almas, Buhadur Ali Muhammad Khan, Sarwar Muhammad Asad, Liaqat Maryyam, Iqbal Asma, Dost Wahidullah
Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan.
Curative Medicine, Kabul University of Medical Sciences, Kabul 10001, Afghanistan.
World J Cardiol. 2025 Apr 26;17(4):104465. doi: 10.4330/wjc.v17.i4.104465.
Congenital junctional ectopic tachycardia (CJET) is a rare but life-threatening arrhythmia in neonates and infants, often refractory to conventional antiarrhythmic therapy. Ivabradine, a selective inhibitor of hyperpolarization-activated cyclic nucleotide-gated channels, has emerged as a promising drug for CJET management.
To evaluate the efficacy and safety of ivabradine in the management of CJET. Specifically, this study aims to analyze the dosing strategies, treatment outcomes, and the role of ivabradine as monotherapy or adjunct therapy in patients who have previously received other antiarrhythmic medications. Additionally, this review seeks to assess the impact of ivabradine on heart rate (HR) control, rhythm conversion, and its overall safety profile to provide evidence-based insights into its clinical use for CJET management.
This systematic review aims to evaluate the outcomes of ivabradine, either as monotherapy or as an adjunctive therapy, in the treatment of CJET. A comprehensive literature search was conducted across multiple electronic databases to identify relevant studies investigating the use of ivabradine in CJET. Stringent inclusion and exclusion criteria were applied to ensure the inclusion of high-quality, peer-reviewed studies. Data extraction and quality assessment were performed independently by two reviewers.
Ten studies, comprising 6 case reports, 3 case series, and 1 cohort study, met the inclusion criteria. Ivabradine doses ranged from 0.025 to 0.28 mg/kg/dose, administered either as monotherapy or in combination with various antiarrhythmic medications. Overall, ivabradine demonstrated promising results in achieving HR control, conversion to sinus rhythm, or stabilization of junctional rhythm. No significant adverse effects related to ivabradine were reported.
The available evidence suggests that ivabradine may be an effective adjunctive therapy or, in some cases, a potential monotherapy for the management of CJET, particularly in cases refractory to traditional antiarrhythmic medications. However, the current evidence is limited by the small sample sizes and retrospective nature of the included studies. Well-designed prospective studies with larger cohorts and longer follow-up periods are warranted to further elucidate the role of ivabradine in CJET management.
先天性交界性异位性心动过速（CJET）是一种在新生儿和婴儿中罕见但危及生命的心律失常，通常对传统抗心律失常治疗无效。伊伐布雷定是一种超极化激活环核苷酸门控通道的选择性抑制剂，已成为治疗CJET的一种有前景的药物。
评估伊伐布雷定治疗CJET的疗效和安全性。具体而言，本研究旨在分析给药策略、治疗结果，以及伊伐布雷定作为单一疗法或辅助疗法在先前接受过其他抗心律失常药物治疗的患者中的作用。此外，本综述旨在评估伊伐布雷定对心率（HR）控制、心律转复的影响及其总体安全性，以便为其在CJET治疗中的临床应用提供循证见解。
本系统综述旨在评估伊伐布雷定作为单一疗法或辅助疗法治疗CJET的结果。在多个电子数据库中进行了全面的文献检索，以识别研究伊伐布雷定在CJET中应用的相关研究。应用严格的纳入和排除标准以确保纳入高质量的、经过同行评审的研究。由两名审阅者独立进行数据提取和质量评估。
10项研究符合纳入标准，包括6例病例报告、3个病例系列和1项队列研究。伊伐布雷定的剂量范围为0.025至0.28mg/剂量，可作为单一疗法或与各种抗心律失常药物联合使用。总体而言，伊伐布雷定在实现心率控制、转复为窦性心律或稳定交界性心律方面显示出有前景的结果。未报告与伊伐布雷定相关的重大不良反应。
现有证据表明，伊伐布雷定可能是治疗CJET的一种有效辅助疗法，在某些情况下也可能是一种潜在的单一疗法，特别是在对传统抗心律失常药物难治的病例中。然而，目前的证据受到纳入研究样本量小和回顾性性质的限制。需要设计良好的、有更大队列和更长随访期的前瞻性研究，以进一步阐明伊伐布雷定在CJET治疗中的作用。
