Walid Mohamed Sallam, Mahmoud Mohamed Ali Ibrahim, Ahmed Fathy Tamara and Hazem Mohamed Khorshid
Background: Ivabradine, a selective if current inhibitor, is widely used to reduce heart rate in patients with ischemic heart disease (IHD) and heart failure (HF). Atrial fibrillation (AF) is a known adverse effect of Ivabradine, but it remains unclear whether baseline left atrial (LA) size influences AF development. This study investigates the relationship between left atrial volume index (LAVI) and incidence of AF in patients treated with Ivabradine.
Methods: This prospective, observational study included 180 patients with HF or IHD receiving guideline-directed medical therapy, with 90 patients treated with Ivabradine and 90 as controls. Clinical and echocardiographic evaluations, including LAVI, LA size, and ejection fraction (EF), were performed. A 12-lead ECG was conducted weekly for the first four weeks and at 8 and 12 weeks to monitor AF development.
Results: No significant difference in AF incidence was found between Ivabradine and control groups (23.3% vs. 20.0%, p = 0.587). However, LAVI was considerably higher in Ivabradine group compared to controls (34.18±4.02 vs. 32.80 ±4.46 mL/m², p = 0.031). Within the Ivabradine group, no notable variations were observed between patients who developed AF and those who did not in terms of LAVI, EF, or CHA2DS2-VASc scores.
Conclusion: Ivabradine therapy showed no relationship with an elevated incidence of AF, irrespective of baseline LA size. Higher LAVI was linked to a greater AF incidence across the entire cohort, suggesting LA enlargement as a potential risk factor.
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