The rationale for repurposing funny current inhibition for management of ventricular arrhythmia

Comparison of Efficacy of Ivabradine With Traditional Therapy in Patients With Left Ventricular Dysfunction

Background: Heart failure patients usually present with disease exacerbation that overburdens the hospitals and also increases the risk of mortality with increased heart rate being the main issue. Consideration is being given to drugs for sole heart rate control in addition to conventional therapy.

Objective: To compare the outcomes of ivabradine to traditional treatment in patients with left ventricular systolic dysfunction.

Methodology: This randomized controlled trial was conducted in the Department of Cardiology, Khyber Teaching Hospital, Peshawar from November 1, 2020, to May 31, 2021. Patients aged 30-65 years of age and of either gender with heart failure were enrolled in the study. Patients were screened for New York Heart Association (NYHA) class and were enrolled into one of the two groups. In group 1, patients were started on traditional treatment, while group 2 patients were given ivabradine as an add-on therapy. Follow-up was made at the end of the second month for evaluation of the outcomes.

Results: Each group had 119 patients, with a mean age of 58.05±4.98 years. Group 1, consisted of 61.3% of the patients in NYHA 3, while 38.65% were in NYHA 4. In group 2, NYHA 3 and NYHA 4 patients were 59.6% and 40.3%, respectively. Upon follow-up, there were greater improvements in group 2 as compared to group 1 based on NYHA classifications, with NYHA 2 [47.05% (group 2) vs. 13.44% (group 1)], NYHA 3 [42.85% (group 2) vs. 61.34% (group 1)] and NYHA 4 [10.08% (group 2) vs. 25.21% (group 1)], p < 0.05.

Conclusions: Obtaining a more optimal heart rate with ivabradine in patients with congestive heart failure is reflected in an improvement in NYHA classification.

Diagnosis and management of junctional ectopic tachycardia in children

Junctional ectopic tachycardia (JET) is more common in its postoperative form. A thorough understanding of its etiology, pathophysiology, and management strategies is essential. Classically, postoperative JET is considered to arise from surgical trauma. Genetic susceptibility and an intrinsic morphologic/functional defect in the conduction system inherent in congenital heart diseases likely play a significant role. The devastating effects on postoperative hemodynamics warrant prompt attention. A multipronged management approach with general measures, pharmacotherapy, and pacing has decreased morbidity and mortality. Amiodarone and procainamide remain the preferred drugs, while ivabradine appears promising. Carefully planned randomized trials can go a long way in developing a systematic management protocol for postoperative JET.