Systematic Reviews
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World J Cardiol. Apr 26, 2025; 17(4): 104465
Published online Apr 26, 2025. doi: 10.4330/wjc.v17.i4.104465
Ivabradine in the treatment of congenital junctional ectopic tachycardia: A systematic review
Syed Faqeer Hussain Bokhari, Muhammad Muaz Mushtaq, Maham Mushtaq, Husnain Ali, Danyal Bakht, Muhayya Faizullah, Almas Asghar, Muhammad Khan Buhadur Ali, Muhammad Asad Sarwar, Maryyam Liaqat, Asma Iqbal, Wahidullah Dost
Syed Faqeer Hussain Bokhari, Muhammad Muaz Mushtaq, Maham Mushtaq, Husnain Ali, Danyal Bakht, Muhayya Faizullah, Almas Asghar, Muhammad Khan Buhadur Ali, Muhammad Asad Sarwar, Maryyam Liaqat, Asma Iqbal, Department of Medicine and Surgery, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Wahidullah Dost, Curative Medicine, Kabul University of Medical Sciences, Kabul 10001, Afghanistan
Author contributions: Bokhari SFH led the conceptualization and overall supervision of the research, providing critical insights into study design and methodology; Mushtaq MM and Mushtaq M were responsible for literature search and data extraction, ensuring that relevant studies were systematically identified and analyzed; Ali H and Bakht D contributed to the statistical analysis and interpretation of findings, helping to establish the study's scientific rigor; Faizullah M and Asghar A were involved in manuscript drafting and revision, ensuring clarity and coherence in presenting the results; Ali MKB and Sarwar MA assisted in critical appraisal and quality assessment of the included studies, strengthening the reliability of the findings; Liaqat M and Iqbal A played a key role in formatting, referencing, and ensuring compliance with journal submission guidelines; Dost W contributed significantly to reviewing and editing the final manuscript, refining the discussion and conclusion to enhance the overall impact of the study. The collaborative efforts of all authors ensured a well-structured and comprehensive systematic review.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this systematic review.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wahidullah Dost, Curative Medicine, Kabul University of Medical Sciences, Kabul 10001, Afghanistan. wahidullahdost96@gmail.com
Received: December 23, 2024
Revised: March 11, 2025
Accepted: April 8, 2025
Published online: April 26, 2025
Processing time: 121 Days and 17.6 Hours
Abstract
BACKGROUND

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.

AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Ivabradine; Congenital junctional ectopic tachycardia; Neonates; Infants; Refractory

Core Tip: Ivabradine, a selective hyperpolarization-activated cyclic nucleotide-gated channel inhibitor, shows promise in managing congenital junctional ectopic tachycardia (CJET) in neonates and infants, especially when conventional antiarrhythmic therapies fail. This systematic review highlights ivabradine's efficacy in controlling heart rate, achieving sinus rhythm, and stabilizing junctional rhythm, with no significant adverse effects reported. Despite the encouraging results, further prospective studies with larger sample sizes and extended follow-up are necessary to establish ivabradine's definitive role in CJET management.