Sinus node inhibitor, ivabradine, reduces heart rate by a novel mechanism and reduces the frequency of impulses from the sinus node, which is the place in the right atrium of the heart that controls the heart rate. This agent is well-tolerated and effective.
Clinical research has shown that ivabradine when administered to patients with symptomatic chronic heart failure, who are on optimal standard medical therapy including betablockers, reduces heart rate and significantly reduces cardiovascular mortality or the number of heart failure admissions to hospital. This drug is recommended for patients who have a persistent heart rate ≥ 70 beats/min* in addition to a maximally tolerated betablocker dose (*in Europe the European Medecine Agency says ≥ 75).
Ivabradine is extremely tolerated with very few side effects. Patients may frequently notice minor visual disturbances that appear as transitory bright lights (luminous phenomena). Patients should be informed of this frequent side effect which is not serious and rarely requires discontinuation of the drug. The agent may also occasionally slow heart rate substantially which would require a reduction of the dose or discontinuation of the drug.