Ivabradine as an Effective Heart Rate Controlling Agent in Coronary Computed Tomography Angiography: A Systematic Review

We systematically reviewed the effectiveness of ivabradine to reduce heart rate prior to coronary computed tomography angiography (CCTA) examination. We collected articles from four databases (PubMed, Medline, Highwire Press, and Science Direct) published in English from January 2012 to February 2014. All studies involving ivabradine with a good image quality were included in this review. Only fifteen studies from seven literatures met the inclusion criteria and were included for analysis. Several premedication methods were used to evaluate the pharmacodynamics of ivabradine to reduce the patient's heart rate prior to CCTA examination ranging from a single dose to multiple doses of ivabradine and a combination of ivabradine and beta-blocker. Most literature agreed that the combination of ivabradine and beta-blocker resulted in a significant heart rate reduction (25.2%; 95% CI-22.8-28.9%) compared to either ivabradine alone (22.4%; 95% CI-18.0-24.3%) or betablocker alone (14.6%; 95% CI-9.0-21.1%). Although ivabradine results in better heart rate reduction than beta-blocker, a combination of both drugs provides an additive effect. With less side effects and better heart rate reductions, ivabradine can be applied clinically as an effective heart rate controlling agent in CCTA examination.