Effect of ivabradine vs atenolol on heart rate and effort tolerance in patients with mild to moderate mitral stenosis and normal sinus rhythm

Journal of Cardiac Failure, 04/02/2012

Ivabradine is more effective than atenolol for effort related symptoms in patients with mild–moderate mitral stenosis and normal sinus rhythm.


  • Fifty patients with mild–moderate mitral stenosis in sinus rhythm were randomized to receive ivabradine or atenolol for 4 weeks each in an open–label, randomized, crossover design trial.
  • A 24–hour Holter and treadmill test was performed at baseline and after each active treatment period.
  • In the first treatment period, 23 patients were allocated to ivabradine (22 analyzed), and 27 were allocated to atenolol (26 analyzed).
  • In the second period, all 48 patients were analyzed.


  • Ivabradine increased the mean total exercise time to 500.7 seconds (SD 99.7) from a baseline of 410.3 seconds (SD 115.4), and atenolol increased it to 463.7 seconds (SD 113.1).
  • The point estimate (absolute difference between ivabradine and atenolol) was 35.27 seconds (95% CI 15.24–55.20; P = .0009).
  • The point estimate for decrease in the maximum exercise heart rate and mean heart rate were 7.64/min (95% CI 0.37–15.9; P = .04) and 5.61/min (95% CI 2.51–8.71; P = .0007), respectively.

Print Article Summary Cat 2 CME Report