Abstract 4144538: Ivabradine in Patients With Postural Orthostatic Tachycardia Syndrome: A Single-Arm Systematic Review and Meta-analysis

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by an excessive increase in heart rate upon standing and other autonomic symptoms. Optimal treatments for this disease are still under research. Ivabradine, a selective inhibitor of the If channel, has emerged as a potential treatment for POTS due to its ability to reduce heart rate without affecting blood pressure. In this context, we conducted a systematic review and meta-analysis to assess the impact of ivabradine on Symptoms in POTS patients. Methods: We systematically searched Pubmed, Embase, and Cochrane databases for studies assessing the efficacy and safety of ivabradine in patients with POTS. We calculated event prevalence for binary outcomes and mean value for continuous outcomes, along with 95% confidence intervals (CI). Statistical analysis was performed using R version 4.3.2. A random-effects model was used for all outcomes, and heterogeneity was assessed with Cochrane's Q and I2 statistics Results: We included ten studies, comprising 267 patients, of whom 130 (48.68%) were females, with a mean age of 34,68 years, and the heart rate (HR) before ivabradine use ranged between 94.20 and 117.66 bpm. The analysis showed an improvement of symptoms in 90.89% (95% CI: 80.34-98.07;) of patients, and a decrease of 14.46 bpm in HR (95% CI: 7.69-21.24; ), which ranged between 79.82 and 98.25 bpm (95% CI; ). Additionally, we observed side effects events in 9.58% of patients (95% CI: 3.69-17.30;). Conclusion: In patients with POTS, ivabradine appears to be a viable treatment option. Further comparative and more powerful studies are necessary to assess the efficacy and safety of ivabradine in this population.