Although the 3 trials did not point to atrial fibrillation as a potential side effect of ivabradine use, the most recent study reported a highly significant increase in the frequency of atrial fibrillation (5.3% vs. 3.8%) in the ivabradine group, and a meta-analysis reported a 15% increase in the risk of atrial fibrillation with ivabradine—an effect that warrants attention. 26 – 28 In this issue of the Journal, Saggu et al 29 present data from a study that was designed to evaluate the cardiovascular effects of ivabradine as compared with metoprolol in patients with mild to moderate mitral stenosis.
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