Ivabradine in the treatment of postural tachycardia syndrome (POTS), a single center experience

Pacing Clin Electrophysiol. 2017 Nov;40(11):1242-1245. doi: 10.1111/pace.13182. Epub 2017 Sep 20.


Background: Ivabradine is a selective If channel blocker that reduces heart rate without affecting other cardiovascular functions. In case reports and case series, it was shown to improve symptoms in patients with postural tachycardia syndrome (POTS).

Methodology and results: This retrospective study examined patients who were diagnosed with POTS and received ivabradine as part of their treatment. Forty-nine patients (47 females, 95.9%) received ivabradine. The average age was 35.1 ± 10.35 years. The most common symptoms were palpitations and lightheadedness and both improved significantly, 88.4% and 76.1% response rate, respectively. A total of 38 patients reported improvement in their symptoms. In addition, ivabradine resulted in an objective decrease in sitting and standing heart rate (78.1 ± 10.7 vs 72.5 ± 7.6, P-value: 0.01) and (107.4 ± 14.1 vs 95.1 ± 13.7, P-value: < 0.001), respectively, with no significant change in blood pressure. The most common reported side effect was luminous phenomena/visual brightness occurring in nine patients. However, none of the patients stopped ivabradine due to side effects.

Conclusion: Our study shows that ivabradine is likely to be effective in treating patients with POTS. Nearly 78% of our cohort reported a significant improvement in symptoms with no major adverse effects reported. A future randomized, placebo-controlled trial is warranted.

Keywords: POTS; ivabradine; postural tachycardia syndrome.

MeSH terms

  • Adult
  • Benzazepines / therapeutic use*
  • Cardiovascular Agents / therapeutic use*
  • Female
  • Heart Rate / drug effects
  • Humans
  • Ivabradine
  • Male
  • Postural Orthostatic Tachycardia Syndrome / drug therapy*
  • Retrospective Studies
  • Treatment Outcome


  • Benzazepines
  • Cardiovascular Agents
  • Ivabradine