الفهرس 
dilated CardiomyopathyOnly 14 pages are availabe for public view
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Abstract
Enhanced heart rate, generally observed in patients with congestive heart failure (CHF) due to increased sympathetic nervous activity, attenuates the impairment in cardiac output or preserves cardiac output at the cost of impaired left ventricular (LV) filling, increased myocardial 02 consumption and reduced coronary perfusion time. Thus, heart rate slowing should in theory be beneficial in CHF.
The rationale for adding Ivabradine, a pure heart rate-lowering agent to a B-blocker is to further reduce the consequences of excessive sympathetic stimulation primarily at the myocardial level in those patients who still have a high resting heart rate despite being therapy with B-blocker.
In this Study, we prospectively assessed the effect of If channel blocker on ambient arrhythmia and basic ECG interval as an add on therapy in patients with idiopathic dilated cardiomyopathy using 24 hours holter monitoring.
This study included 35 patients with the diagnosis of idiopathic dilated cardiomyopathy in sinus rhythm with LVEF<40% and were receiving the maximally tolerated dose of ACEI and carvedilol in addition to aldosterone antagonist and other medications as the clinical status dictated.
The patients were followed up for three months with emphasis on heart rate and blood pressure measurement, NYHA functional class, electrocardiographic parameters,24 hour holter monitoring and echocardiographic parameters including LV dimensions and volumes, LVEF.
In this study, there was a significant reduction in the resting heart rate by a mean of 27.1% without a significant change in blood pressure. There was a positive correlation between the resting heart rate achieved in the whole study population and the NYHA functional class .
This heart rate reduction was associated with a significant reduction of the left ventricular diameters and volumes, without significant changes in LVEF.
No significant side effects that led to drug discontinuation) were reported by the patients.
from the results of the present study, we conclude that heart rate reduction in patients with idiopathic dilated cardiomyopathy is associated with a better NYHA functional class and a regression in left ventricular dimensions and volumes. Also, Ivabradine can be used safely as an add on therapy in patients with idiopathic dilated cardiomyopathy and sinus rhythm.
As a pilot study, larger randomized studies with longer periods of follow-up are recommended to investigate the long-term effects of Ivabradine in patients with idiopathic dilated cardiomyopathy .