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Vol. 73. Issue 12.
Pages 1083-1084 (December 2020)
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Vol. 73. Issue 12.
Pages 1083-1084 (December 2020)
Letter to the Editor
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Do we have a new drug for heart rate control in patients with permanent atrial fibrillation? Response
¿Hay un nuevo fármaco disponible para el control de la frecuencia cardiaca de pacientes con fibrilación auricular permanente? Respuesta
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Adolfo Fontenlaa,
Corresponding author
drfontenla@gmail.com

Corresponding author:
, Juan Tamargo Menéndezb, María López Gila, Fernando Arribasa,c
a Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
b Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
c Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
Related content
Rev Esp Cardiol. 2020;73:1082-310.1016/j.rec.2020.07.013
Nuria Rivas-Gándara, Jaume Francisco-Pascual
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To the Editor,

We thank Drs Rivas-Gándara and Francisco-Pascual for their interest shown in the BRAKE-AF project.1

There is indeed evidence to suggest that ivabradine could be effective for rate control in permanent atrial fibrillation (AF). Following publication of its efficacy in a patient with poorly-controlled AF,2 we were aware that to “make this hypothesis a reality” we would need to conduct a clinical trial.3

Permanent AF is the most common form of AF yet, surprisingly, new drugs for rate control have not been developed in the past 30 years. The industrial development of antiarrhythmic drugs is increasingly uncommon, probably because it involves investment that is risky and/or with small profit margins; this means that clinicians must assess the antiarrhythmic effect of drugs that are marketed for other indications, as is the case with ranolazine.4 We would like to point out that the BRAKE-AF project was undertaken with public funding only and thanks to the generous effort of independent investigators: cardiologists from several hospitals and pharmacologists from the Universidad Complutense de Madrid.

Our trial is currently in the recruitment phase, and bears the difficulties inherent to any clinical trial with the added impact of the recent COVID-19 outbreak. Like Rivas-Gándara and other authers,5 we hope that the BRAKE-AF trial will answer the question of whether there is a new drug for rate control in AF. If so, the next question will be, “Could ivabradine improve prognosis in patients with permanent AF?”

References
[1]
A. Fontenla, M. Lopez-Gil, J. Tamargo-Menendez, et al.
Ivabradine for chronic heart rate control in persistent atrial fibrillation. Design of the BRAKE-AF project.
Rev Esp Cardiol., 73 (2020), pp. 368-375
[2]
A. Fontenla, L. Villagraz, J. De Juan, A. Lozano, S. Giacoman, M. Lopez-Gil.
Ivabradine as an alternative to AV node ablation in a patient with permanent atrial fibrillation.
Rev Esp Cardiol., 70 (2017), pp. 1019-1020
[3]
A. Fontenla, L. Villagraz, A. Lozano, M. López-Gil.
Ivabradine as an atrioventricular node modulator. Promise or reality?.
Response. Rev Esp Cardiol., 70 (2017), pp. 1024
[4]
G.M. De Ferrari, L.S. Maier, L. Mont, et al.
Ranolazine in the treatment of atrial fibrillation: Results of the dose-ranging RAFFAELLO (Ranolazine in Atrial Fibrillation Following An ELectricaL CardiOversion) study.
Heart Rhythm., 12 (2015), pp. 872-878
[5]
M. Abdelnabi, A. Ahmed, A. Almaghraby, Y. Saleh, H. Badran.
Ivabradine and AF: Coincidence, Correlation or a New Treatment?.
Arrhythm Electrophysiol Rev., 8 (2020), pp. 300-303
Copyright © 2020. Sociedad Española de Cardiología
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