Ivabradine for the Treatment of Acute Mitral-Regurgitation-Related Decompensated Heart Failure.

Ivabradine is used as a second-line medication for chronic heart failure (HF) but is still off-label for acute HF. We report the case of a 50-year-old man who experienced infectious endocarditis-related acute severe mitral regurgitation (MR) and acute decompensated HF and showed quick improvement of clinical symptoms after ivabradine use. An unstable hemodynamic status does not allow titration of a β-blocker dose, and a β-agonist might be needed to overcome a critical condition. Ivabradine appears to solve this issue and protect the myocardium owing to prolongation of the diastolic perfusion time. Ivabradine might be useful for the treatment of acute severe MR-related acute decompensated HF due to the improvement of diastolic function by decreasing the heart rate.