Hi Kumar, yes you can use ivabradine, as long as you monitor the effects of the drug. Its recommended administration is twice daily, therefore you should start with the five mg dose. However, since by definition the IST is self terminating, you should monitor if excessive bradycardia rhythms appear when the patient is in sinus rhythm, and then you can optimize dosage.

It is def. worth trynig since ivabradine has relatively low incidence of side effects and is well tolerated by majority of patients. There are some studies with short-term positive results but long-term efficacy is not known. In addition, there are also no RCT I am aware of. 

I recommend this editorial from JACC: http://content.onlinejacc.org/article.aspx?articleid=1358180 to broaden the horizon.

Hi Anil,

You certainly can safely use ivabradine in IST, but there is no evidence supporting the use. Beta-blocking agents and diltiazem/verapamil are much cheaper and should be used first. I only use ivabradine if the other drugs fail or aren't well tolerated, and provided the patient can pay the drug. This is and remains a rare indication. In such situations I would rather prefer an EF examination and a selective ablation of hyperactive pacemaker cells, if present. 

Best regards,

Thierry

yes we can use ivabradine in this situation  5 mg twice a day. The drug can be even combined with Beta blockers 

I use Ivabradine because BBloq and Diltyazem it´s no toereted by this kind of patientes,  now a days I have more than 50 pts with Ibabradine and they are ecellent

Definitely can use ivabradine. I treat many patients with IST and find that beta blockers and calcium channel blockers even someimes in combination with flecainide rarely works. Unfortunately in the US we still don't have access to ivabradine but there are many in Europe and in Australia where ivabradine has been used successfully to treat this very difficult condition. I'm assuming you've excluded all other causes of sinus tachycardia.

Definitely yes. I have used it in several patients with very gratifying results.

You might be interested in this paper:

Cappato R, et al. Clinical Efficacy of Ivabradine in Patients With Inappropriate Sinus Tachycardia: A Prospective, Randomized, Placebo-Controlled, Double-Blind, Crossover Evaluation. J Am Coll Cardiol 2012;60:1323–9 

doi: 10.1016/j.jacc.2012.06.031  

http://content.onlinejacc.org/article.aspx?articleid=1358179&resultClick=1