L'ivabradine, un inhibiteur sélectif du courant If sinusal: une nouvelle approche thérapeutique des cardiopathies ischémiques

The selective inhibitor of sinus node If current ivabradine: a new therapeutic approach to ischaemic heart disease Coronary artery diseases remain the major cause of morbidity and mortality, and affect public health of industrialised countries. Chronic elevated heart rate is a predictive factor for mortality in patients with coronary disease but also in the general population. It is not known whether reduction of heart rate per se can improve outcome of patients with coronary disease. After acute myocardial infarction, several studies with betablockers suggest that a reduced heart rate might be beneficial. However, beta-blockers may be contraindicated in some patients or poorly tolerated. Similarly, lowering heart rate with amiodarone or calcium antagonists is associated with modest event-rate reduction and only in selected patients. The new selective inhibitor of the sinus node If current, ivabradine, looks promising in terms of reducing myocardial ischaemia. The exclusive reduction of heart rate provides comparable efficacy to existing treatments. Ivabradine is very well tolerated and is licensed in Switzerland and Europe for use in stable angina.