Targeting heart rate variability in heart failure: an expert opinion review on Ivabradine

Abstract

Heart rate variability (HRV) in patients with chronic heart failure (CHF) predicts mortality outcomes. Assessed in time-domain and frequency-domain measures, HRV can be used to risk stratify patients with CHF. Among various interventions, lifestyle measures and various medications used to treat CHF can improve HRV. Here, we reviewed current evidence with ivabradine and its effect on HRV in patients with CHF. Besides reducing the resting and 24-hour mean heart rate (HR), ivabradine improves the HRV in patients with CHF. The improved HRV is evident in awake phase as well as during sleep. The improved HRV is seen on top of guideline-directed optimal medical therapy inclusive of beta-blockers. In our opinion, HRV should be assessed routinely in patients with CHF. Further research is required to understand the impact of improved HRV in altering the outcomes in patients with CHF. In conclusion, for CHF patients with reduced HRV, addition of ivabradine improves HRV on top of exiting therapy.