Single centre experience of ivabradine in postural orthostatic tachycardia syndrome

Europace. 2011 Mar;13(3):427-30. doi: 10.1093/europace/euq390. Epub 2010 Nov 9.


Aims: Postural orthostatic tachycardia syndrome (POTS) is associated with tachycardia on orthostasis. Patients frequently report palpitations, presyncope, and fatigue. Conventional therapy is effective in less than 60%. Case reports suggest ivabradine (a selective sinus node blocker, with no effect on blood pressure) may alleviate POTS-related symptoms. This is a retrospective case-series.

Methods and results: Postural orthostatic tachycardia syndrome patients prescribed ivabradine were identified from the pharmacy database. Case notes were reviewed and participants completed a symptom assessment tool. Twenty-two patients were identified. Data were available from 20. Eight patients reported reduced tachycardia and fatigue and four reported only reduced tachycardia. The most common reason for discontinuing ivabradine was lack of efficacy (n = 6). Five patients reported side-effects resulting in two discontinuing treatment.

Conclusion: This retrospective case series indicates that 60% of patients treated with ivabradine report a symptomatic improvement. A randomized controlled trial accessing the efficacy of ivabradine in POTS is indicated, particularly in patients resistant to, or intolerant of, conventional therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Benzazepines / adverse effects
  • Benzazepines / pharmacology
  • Benzazepines / therapeutic use*
  • Case-Control Studies
  • Fatigue / epidemiology
  • Female
  • Heart Rate / drug effects
  • Heart Rate / physiology
  • Humans
  • Incidence
  • Ivabradine
  • Male
  • Middle Aged
  • Orthostatic Intolerance / drug therapy*
  • Orthostatic Intolerance / epidemiology
  • Orthostatic Intolerance / physiopathology
  • Retrospective Studies
  • Sinoatrial Node / drug effects
  • Sinoatrial Node / physiopathology
  • Tachycardia / drug therapy*
  • Tachycardia / epidemiology
  • Tachycardia / physiopathology
  • Treatment Outcome


  • Benzazepines
  • Ivabradine