Pre-treatment with a sinus node blockade, ivabradine, before coronary CT angiography: A retrospective audit

Aim: To evaluate whether a simple pre-treatment regimen of sinus node inhibition by ivabradine taken at home for only 1 day resulted in a lower pre-scanning heart rate (HR) and reduced the need for intravenous beta-blockers (BB) prior to coronary computed tomography angiography (CTA). Materials and methods: The pre-treatment regimen for coronary CTA changed from using no medication at home (group 1 patients) to the use of 5 mg ivabradine twice a day (group 2 patients), to using 7.5 mg ivabradine twice a day (group 3 patients). The target HR was the same for groups 1 and 2, but lower for group 3. HRs and the use of intravenous BB before coronary CTA was performed were compared between the study groups. Results: The mean HR immediately before the planned CTA procedure was significantly lower throughout groups 1–3 with values of 70 ± 12.9, 64.9 ± 9.8, and 63.2 ± 10.6 beats/min in groups 1, 2, and 3, respectively (p < 0.001). This resulted in a significantly diminished use of intravenous BB in group 2 (mean 5.1 ± 5.8 mg) compared to group 1 (mean 9 ± 7.6 mg; p = 0.002). The target HR of 65 beats/min was achieved in 37%, 47%, and 61% of groups 1, 2, and 3, respectively (p < 0.0001). Conclusion: In conclusion, the administration of ivabradine tablets at home for only 1 day to patients scheduled for coronary CTA resulted in a significantly lower in-clinic HR and a significantly lower mean use of intravenous BB