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The place of Ivabradine in management of chronic heart failure patient with implanted cardiac resynchronization therapy - case report

Zhenya Marinova, Roksana Tsvetanova, Elena Ivanova, Dimitar Hristov, Lilyana Mircheva


Introduction: Heart failure is a syndrome characterized by typical symptoms (e.g. dyspnoea, pretibial oedema, fatigue) caused by structural and/or functional cardiac abnormalities, resulting in reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. It is end-stage of all car­diovascular diseases and due to its wide spread may easily be described as an epidemic of 21st century.

Materials and methods: We present a case of 52-year-old male with a history of coronary artery dis­ease who underwent percutaneous coronary intervention due to chest pain with implantation of 2 drug-eluting stents. In 2016 after suffering anterior myocardial infarction he was hospitalized again and another PCI of stent thrombosis of the proximal LAD was performed. During the patient`s hos­pital stay an ejection fraction of 30% and left bundle branch block were established and he devel­oped signs of total HF. The combination of low EF and LBBB lead to the implantation of CRT-D. On 03.2017 he was urgently admitted to II. Cardiology Clinic in UMHAT `St. Marina` with progressive symptoms of CHF. After a correction of therapy and optimization of the CRT-D under ultrasound control the patient had subjective improvement and reduction of swelling. Due to lack of adequate heart rate control after correction of CRT parameters and optimal dose of beta-blocker, Ivabradine was added to patients therapy.

Results: The following check-ups showed significant improvement, no symptoms of exacerbated HF, no readmissions due to the condition and NYHA class II-III.

Conclusion: Management of HF patients with CRT should follow the same algorithm as in all other HF patients. In cases of sinus rhythm and HR>70/min Ivabradine is a drug of choice for HR control which also improves physical capacity and quality of life. However, despite the availability of numer­ous therapy methods that increase the life expectancy of these patients, the prognosis remains poor.


heart failure; CRT; Ivabradine; management



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