Ivabradine effects on COVID-19-associated postural orthostatic tachycardia syndrome: a single center prospective study, 2023,

Ivabradine effects on COVID-19-associated postural orthostatic tachycardia syndrome: a single center prospective study


Background: A wide range of cardiac arrhythmias were reported in the setting of active infection or as a complication of COVID-19. The main pathophysiology can be attributed to dysautonomia or autonomic nervous system dysfunction. Postural orthostatic tachycardia syndrome (POTS) is a complex, multisystemic disorder affecting usually younger age with tachycardia at rest or with minimal effort being the main symptom. Data regarding the safety and efficacy of ivabradine in POTS treatment is limited to small studies and case reports.

Methods: This prospective observational study included a total of 55 COVID-19-associated POTS patients after the exclusion of other causes of tachycardia. Ivabradine 5 mg twice daily was initiated. Re-assessment of patients’ symptoms, heart rate, and heart rate variability (HRV) parameters’ changes after 3 days of ivabradine therapy was done.

Results: The mean age of the included patients was 30.5±6.9 years with 32 patients being males (58.2%). 43 of 55 (78%) of the included patients reported significant improvement of the symptoms within 7 days of ivabradine therapy. 24-hour heart rate (minimum, average, and maximum) was significantly lower (p-value < 0.0001*, = 0.001*, < 0.0001* consecutively) with a significant difference in HRV time-domain parameters (SDNN, rMSSD) (p-value < 0.0001*) after ivabradine therapy.

Conclusion: In a prospective study that evaluated the effects of ivabradine in post-COVID-19 POTS, patients treated with ivabradine reported improvement of their symptoms within 7 days of ivabradine treatment with a significant reduction of 24-hour average, minimum, and maximum heart rate, and improvement of HRV time domains parameters. Ivabradine might be a useful option to relieve symptoms of tachycardia in COVID-19 POTS. Further research is required to confirm the safety and efficacy of ivabradine in POTS treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10352820/

 

"Baseline patient demographic and clinical data

The mean age of the included patients was 30.5±6.9 years, 32 patients were males (58.2%), and the mean number of days after COVID-19 diagnosis was 13.5±5.6 days. The mean resting heart rate was 84.4±13.8 beats/minute. The mean left ventricular ejection fraction (LVEF) was 66.3±6.8% (Clinical data illustrated in Table 2). "

Mean number of days since Covid infection is less than 2 weeks. I don't think this will relate in any way to Long-Covid and I wonder how anybody gets diagnosed with POTS this shortly after an acute infection. It seems it would have been easy to recruit Long-Covid patients with POTS.