Effectiveness of ivabradine in a paediatric case of cardiomyopathy secondary to a noradrenaline-producing paraganglioma.

A boy with heart failure and mechanical pulsus alternans was treated with enalapril malate and carvedilol; however, left ventricular contraction did not improve. After treatment with ivabradine, the pulsus alternans disappeared, and left ventricle contraction improved. Thorough evaluation revealed an abdominal paraganglioma producing noradrenaline, and excision of the tumor normalised the left ventricle contraction. Catecholamine-induced cardiomyopathy caused by paragangliomas is an extremely rare but important differential diagnosis of dilated cardiomyopathy. Thus, ivabradine is a good candidate for the treatment of heart failure, even in the presence of catecholamine-producing tumours.