J Cardiovasc Pharmacol

Ivabradine reduces orthostatic tachycardia, symptom burden in POTS

August 8, 2025

Study details: This pilot study evaluated ivabradine, a selective I_f channel blocker typically used in heart failure, in ten patients diagnosed with postural orthostatic tachycardia syndrome (POTS). Participants (mean age, 28; 80% female) had persistent symptoms despite standard non-pharmacologic interventions. Ivabradine was administered to assess its impact on heart rate and symptom burden upon standing, and changes in POTS symptoms were measured by Malmö POTS symptom score.

Results: Before ivabradine treatment, all patients had persistent symptoms, with a median Malmö score of 86 (range: 59–99); all scores were ≥42, indicating significant symptom burden. Following treatment, the median Malmö score significantly decreased to 39 (P=0.005). Ivabradine also reduced the average heart rate increase upon standing from 40 bpm to 15 bpm (P=0.011). Patients reported a 69% reduction in feeling faint and a 66% reduction in chest pain. Additional improvements were noted in fatigue, brain fog, and exercise intolerance. BP remained stable throughout treatment.

Clinical impact: These findings suggest that excessive heart rate—not hypotension—may be a primary driver of POTS symptoms. Ivabradine’s ability to modulate heart rate without lowering BP may offer a targeted therapeutic option for patients unresponsive to conventional strategies. Further controlled trials are warranted to validate efficacy and guide clinical use.

Source:

Marchetta M, et al. (2025, June 19). J Cardiovasc Pharmacol. Heart Rate Lowering With Ivabradine and Burden of Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. https://pubmed.ncbi.nlm.nih.gov/40294227/