Risk of Atrial Fibrillation Induced by Ivabradine in Correlation with Left Atrial Size

Abstract

Background: Ivabradine (Procoralan, Servier) is a heart rate lowering drug which acts by specifically inhibiting the pacemaker If current, which causes spontaneous depolarization in the sino-atrial node that regulates the heart rate. Objective: To correlate Left atrial size with development of AF in patients treated with ivabradine over a 12 week period. Patients and Methods: Our study was conducted upon 180 patients referred to Ain Shams University Hospital and Misr University for Science and Technology hospital, from September 2020 to February 2021 to undergo treatment for HF or IHD with the appropriate medications with AF being the primary outcome of interest and how it correlates with Ivabradine therapy. Results: Our results showed that there was no statistically significant difference between the two groups regarding the incidence of AF (p= 0.587). Likewise, there was no statistically significant difference between the two groups regarding duration till AF at 1st month, 2nd month and 3rd month (p>0.05). This could be explained by the lower number of patients included in the study as compared to other similar studies. When the entire patient population who developed AF was pooled regardless of their Ivabradine use, there was a statistically significant increase in AF incidence with larger left atrial volume indices. Conclusion: In the present study, Ivabradine treatment was not associated with a higher incidence of AF in patients with heart failure and/or ischemic heart disease. Also, there was no significant difference in the duration until AF occurrence when it was evaluated at the end of the 1st, 2nd, and 3rd months. Higher LAVI was associated with a higher incidence of AF in the total studied patient population regardless of Ivabradine use.