Effect of Ivabradine in Controlling Heart Rate in Patients with Sepsis and Septic Shock: Randomized Control Trails

Abstract

Background: Ivabradine is a selective inhibitor of (If) channels in the sinoatrial node and a pure bradycardic agent with no deleterious effect on other aspects of cardiac function nor on blood pressure. This study was conducted to evaluate the effect of Ivabradine on controlling tachycardia in sepsis patients as compared to placebo. Methods: A total of 100 patients admitted to the Medical Intensive Care Unit (MICU) were recruited in this randomized controlled trial. A total of 50 patients were randomly allocated to either Group A (the Ivabradine group) or Group B (the control group). Heart rate (HR) was recorded for all patients at baseline, 12, 24, 48, 72, 96, and 120 hours. Mean arterial pressure (MAP), ejection fraction (EF), and change in Norepinephrine (NE) dosage were recorded at baseline and post-intervention (120 hours). A mortality rate was recorded for both groups. Results: The patients had a mean age of 32.49 + 16.22 years. There were 56 males and 44 females in the study. Epilepsy (n = 12, 12%) and tetanus (n = 11, 11%) were the most common primary diagnosis. Ventilator Associated Pneumonia (n = 60) was found to be the most common infection. Patients in Group A (23.2 + 11.02 beats per minute) had a significantly greater heart rate reduction at 120 hours in mean heart rate as compared to Group B patients (8.92 + 30.46 beats per minute, p = 0.002). The increase in mean MAP for Group A (1.68 + 2.44 mm Hg) was also significantly greater than that for Group B (0.54 + 2.46 mm Hg, p = 0.022). There was no difference in the mean change in NE dosage between Groups A (0.63 + 0.25 units/minute) and B (-0.34 + 0.36 units/minute, p = 0.106). A significantly greater increase in EF was found for Group A (1.16 + 1.5%), in comparison to Group B (0.30 + 1.69 %, p = 0.009). There were 22 (44%) deaths reported in Group A as compared to 24 (48%, p = 0.688) in Group B. Conclusion:Ivabradine has a significantly greater effect on controlling heart rate as compared to placebo in sepsis patients. The use of Ivabradine should be included in clinical guidelines for managing sepsis patients in ICU settings. Doi: 10.28991/SciMedJ-2023-05-01-04 Full Text: PDF