Ivabradine in acute care: Revisiting the funny current in critical care context

Table 1 Use of ivabradine in intensive care unit

Ref.	Study population	Study type No. of patients	Outcome measured	Implications for clinical practice
Zheng et al[4], 2024	Sepsis	Prospective, multicenter, randomised, open-label (n = 172)	Difference in reduction in HR below 95 bpm and the effect of ivabradine on hemodynamics between the standard treatment group and the ivabradine group within the first 96 hours after randomisation	Trial ongoing
Colombo et al[5], 2022	Cardiogenic shock on mechanical circulatory support	Case series (n = 6)	HR, stroke volume, ECMO flow, vasopressor requirements	Significant reduction in HR observed after ivabradine administration. SV improvement allowing the reduction of ECMO flow support and vasopressors administration
Datta et al[6], 2021	Septic shock	RCT (n = 60)	HR, stroke volume, vasopressor dose, survival outcomes	Enteral ivabradine is effective in reducing HR, improving haemodynamic parameters, and cardiac function
Nguyen et al[7], 2018	Low cardiac output syndrome treated by dobutamine after elective coronary artery bypass surgery	Multicenter RCT (n = 19)	HR, cardiac index, continuous CO monitoring	IV ivabradine achieved effective and rapid correction of sinus tachycardia. Simultaneously, stroke volume and systolic blood pressure increased, suggesting a beneficial effect of this treatment on tissue perfusion
Nuding et al[8], 2018	Multiple organ dysfunction syndrome	Single-centre RCT (n = 70)	HR reduction ≥ 10 bpm at 96 hours, hemodynamics, disease severity, vasopressor use, mortality	HR reduction after oral ivabradine did not differ significantly between groups. It did not affect hemodynamics or disease severity
Barillà et al[9], 2016	STelevation myocardial infarction complicated by cardiogenic shock	Single-centre RCT (n = 58)	HR reduction, clinical, and hemodynamic outcomes	Associated with a short-term favourable outcome and can be effectively administered by nasogastric intubation
Gallet et al[10], 2014	Severe systolic dysfunction	RCT (n = 22)	HR, diastolic function, perfusion, cardiac output	Demonstrates the safety and potential benefit of as HR HR-lowering agent
De Santis et al[11], 2014	MODS	Case report (n = 3)	Hemodynamic variables	HR reduction in MODS patients
Franke et al[12], 2011	Acute heart failure due to myocarditis	Case report (n = 2)	Hemodynamic variables	Beneficially influence outcome by allowing optimisation of the patient′s HR
Swedberg et al[1], 2010	Chronic heart failure	Randomised placebo-controlled (n = 6558)	Composite of cardiovascular death or hospital admission for worsening heart failure	HR is reduced with improvement in clinical outcomes

HR: Heart rate; ECMO: Extracorporeal membrane oxygenation; SV: Stroke volume; MODS: Multi-organ dysfunction syndrome; RCT: Randomised controlled trial.

Table 2 Comparison of ivabradine and beta-blockers

Variable	Ivabradine	Beta-blockers
Mechanism	Blocks If channels in SA node (reduces HR only)	Block β1/β2-adrenergic receptors (reduces HR + BP)
Common side effects	Luminous phenomena (visual brightness). Bradycardia. Headache. Rare: Atrial fibrillation	Fatigue. Cold. hands/feet. Bronchospasm (worsens COPD/asthma) Erectile dysfunction. Sleep disturbances. Depression
Metabolic effects	Neutral (no impact on glucose/Lipids)	May worsen: Insulin resistance. Triglycerides (↑). HDL (↓)
Contraindications	HR < 60 bpm. Acute heart failure. Pacemaker-dependent	Asthma/COPD. Severe bradycardia. Heart block (2nd/3rd degree)
Advantages	Pure HR control. Safe in lung diseases. No sexual dysfunction. No metabolic interference	Broader benefits (angina, HTN, post-MI). Lower cost
Uses	COPD/asthma patients. Diabetes patients. HR reduction without BP effects	Hypertension. Post-heart attack. Arrhythmias

HR: Heart rate; BP: Blood pressure; HDL: High-Density Lipoprotein; COPD: Chronic obstructive pulmonary disease; HTN: Hypertension, MI: Myocardial infarction; SA: Sinoatrial; If: Funny current.