the Role of Ivabradine in Causing AF in Patients With Chronic Coronary Syndrome

Study Overview
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Brief Summary
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This study is aiming to detect the possibility of Ivabradine's role in the development of atrial fibrillation in chronic coronary syndrome patients with No structural heart disease.

Detailed Description
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Ivabradine is a heart rate-lowering agent best characterized by its negative chronotropic effect on the sinoatrial node. Its unique mechanism selectively blocks the pacemaker funny channels, which are responsible for spontaneous depolarization in the sinoatrial node that regulates heart rate during sinus rhythm. It has been well established that controlling the heart rate is the main target when treating coronary artery disease and heart failure and is associated with a beneficial effect on mortality and morbidity. According to the European Society of Cardiology guidelines for Chronic coronary syndrome, ivabradine should be considered as an anti-anginal agent in patients with sinus rhythm and heart rate of ≥70 BPM in combination with beta-blockers or when beta-blockers are not tolerated. The If current, which is affected by ivabradine, was found to be present in the pulmonary vein myocardial sleeves, the well-recognized triggers for AF. This may explain the risk of AF in patients receiving this drug. However, AF is commonly associated with HF and ischemic heart disease, the current two clinical indications for the use of ivabradine, hence AF in this patient population may be an association rather than a drug-induced effect. Previously, ivabradine's heart rate reduction was thought to be exclusively due to inhibition of If channels in the sinoatrial node. However, emerging data have shown channels that maintain the If current in the free wall of both atria. These findings support the idea that the If current plays a role in the pathophysiological procedure that initiates and maintains AF.

Official Title
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Ivabradine and Its Role in the Development of Atrial Fibrillation in Patients With Chronic Coronary Syndrome

Conditions
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AF - Atrial Fibrillation

Intervention / Treatment
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* Drug: Ivabradine
* Diagnostic Test: transthoracic echo
* Device: 24 hours holter


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age range from 18 to 70 years. diagnosed with Chronic Coronary syndrome according to European association guidelines of 2019. Normal structural heart disease (as evident by 2D transthoracic echocardiography). in sinus rhythm. Exclusion Criteria: Patient with heart rate below 70 bpm at the start of treatment. Smokers. hyperthyroidism. Hypertensive patients Patient with bradycardia arrhythmia (sinus Bradycardia, advanced degree of heart block). history of Atrial fibrillation. history of Myocardial infarction, Previous PCI, or CABG. Patient with Valvular heart disease.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Ivabradine Group<br>patients with chronic coronary syndrome using Ivabradine for heart rate control or as anti-anginal treatment. | Drug: Ivabradine<br>* follow up chronic coronary syndrome patients receiving Ivabradine for ( 6 months ) if the participants develop atrial fibrillation using 24 hours holter .<br>* Other names: Procoralan , Corlanor,;Diagnostic Test: transthoracic echo<br>* performing baseline transthoracic echo for all patients to exclude any chamber dilatation<br>* Other names: TTE;Device: 24 hours holter<br>* perform 24 hours Holter monitoring for all patients at the start of the study and follow up after 6 months<br>|
| Non-Ivabradine Group<br>patients with chronic coronary syndrome NOT using Ivabradine for heart rate control or as anti-anginal treatment. | Diagnostic Test: transthoracic echo<br>* performing baseline transthoracic echo for all patients to exclude any chamber dilatation<br>* Other names: TTE;Device: 24 hours holter<br>* perform 24 hours Holter monitoring for all patients at the start of the study and follow up after 6 months<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| detect the incidence of Ivabradine-induced AF in patients with chronic coronary syndrome | detect the role of Ivabradine's in the development of atrial fibrillation in chronic coronary syndrome patients with No structural heart disease. | 6 months after the start of Ivabradine treatment |