Ivabradine is a drug more recently introduced as a treatment for heart failure conditions. It was originally developed as a treatment for angina, receiving its European Medicines Licence in 2005.

Ivabradine has one action, which is to lower the heart rate, and it is categorised as a selective If current inhibitor. This is the current which is found in the sinoatrial node, which is the area at the top of the heart which produces the electrical impulses to make the heart beat regularly. It is sometimes referred to as the hearts pacemaker. The f in the abbreviation, rather strangely, stands for ‘funny’. This is because when it was first discovered its actions were thought to be unusual compared to other known electrical currents in the heart. The If current controls the action of the hearts pacemaker and therefore the rate at which the heart beats. By partially blocking this current ivabradine lowers the heart rate.

The effect of ivabradine in lowering the heart rate decreases the heart muscles need for oxygen, whilst also improving oxygen supply. Also, its effect has been shown not to reduce the force of contraction of the heart.

The results of a large research study, called the SHIFT trial, were published in 2010 and ivabradine was shown to be beneficial when used in conjunction with the standard heart failure therapy.

Ivabradine is now part of the standard recommended treatment regime for heart failure conditions and in 2012 NICE, (National Institute for Clinical Care and Excellence), published guidelines for it’s use. These are:

• New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction, (this is a common I to IV scale used to roughly describe the severity of symptoms in someone with heart failure).
• In sinus (normal) rhythm with a heart rate of 75 beats per minute or more
• A left ventricular ejection fraction of 35% or less

Ivabradine is an additional treatment option for people with a condition like dilated cardiomyopathy and is used with the standard heart failure treatments, ACE inhibitors and beta blockers etc. where the initial therapy has not shown to be fully effective. It can be used in conjunction with beta blockers, or as an alternative where a person finds the side effects of beta blockers intolerable or where they have a condition such as asthma, which would make beta blockers unsuitable.

Common side effects of ivabradine are visual changes, with increased brightness of vision, occasionally blurred vision and headaches.