Ten-Year Results of a Single-Center Trial Investigating Heart Rate Control with Ivabradine or Metoprolol Succinate in Patients After Heart Transplantation.

Sinus tachycardia after heart transplantation (HTX) due to cardiac graft denervation is associated with reduced post-transplant survival and requires adequate treatment. We analyzed the long-term effects of heart rate control with ivabradine or metoprolol succinate in HTX recipients. This observational retrospective single-center study analyzed the ten-year results of 110 patients receiving ivabradine ( = 54) or metoprolol succinate ( = 56) after HTX. Analysis included comparison of demographics, medications, heart rates, blood pressure values, echocardiographic features, cardiac catheterization data, cardiac biomarkers, and post-transplant survival including causes of death. Both groups showed no significant differences concerning demographics or medications (except for ivabradine and metoprolol succinate). At 10-year follow-up, HTX recipients with ivabradine showed a significantly lower heart rate (72.7 ± 8.5 bpm) compared to baseline (88.8 ± 7.6 bpm; < 0.001) and to metoprolol succinate (80.1 ± 8.1 bpm; < 0.001), a significantly lower NT-proBNP level (588.4 ± 461.4 pg/mL) compared to baseline (3849.7 ± 1960.0 pg/mL; < 0.001) and to metoprolol succinate (1229.0 ± 1098.6 pg/mL; = 0.005), a significantly lower overall mortality (20.4% versus 46.4%; = 0.004), and mortality due to graft failure (1.9% versus 21.4%; = 0.001). Multivariate analysis showed a significantly decreased risk of death within 10 years after HTX in patients with post-transplant use of ivabradine (HR 0.374, CI 0.182-0.770; = 0.008). In this single-center trial, patients with ivabradine revealed a significantly more pronounced heart rate reduction, a lower NT-proBNP level, and a superior 10-year survival after HTX.