Adjuvant Use of Ivabradine in Acute Heart Failure due to Myocarditis

Jennifer Franke, Dorothee Schmahl, Stephanie Lehrke, Regina Pribe, Raffi Bekeredjian, Andreas O Doesch, Philipp Ehlermann, Philipp Schnabel, Hugo A Katus, Christian Zugck, Jennifer Franke, Dorothee Schmahl, Stephanie Lehrke, Regina Pribe, Raffi Bekeredjian, Andreas O Doesch, Philipp Ehlermann, Philipp Schnabel, Hugo A Katus, Christian Zugck

Abstract

We report two cases of young men in whom acute heart failure due to myocarditis was diagnosed. The patients had been transferred to the intensive care unit (ICU) with commencing symptoms of acute heart failure and consecutive multiorgan failure for further treatment and to evaluate the indication for implantation of a ventricular assist device or for high urgent orthotopic heart transplantation. In both patients, the I(f)-channel inhibitor ivabradine was administered off-label to provide selective heart rate reduction, and thus support hemodynamic stabilization. Though currently considered off-label use in patients suffering from severe hypotension and acute heart failure, the use of ivabradine may beneficially influence outcome by allowing optimization of the patient's heart rate concomitant to initial measures of clinical stabilization.

Figures

Figure 1
Figure 1
Therapy and hemodynamic parameters of patient no. 1 and no. 2 throughout the first nine days of intensive care treatment. IABP: intra-aortic balloon counterpulsation.
Figure 2
Figure 2
Epicardial late enhancement in the basal inferolateral region in cardiac MRI.
Figure 3
Figure 3
Inflammatory cardiomyopathy with mononuclear infiltration in histopathological analysis.

References

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Source: PubMed

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