Chronic stable angina pectoris (CSAP) is the most common manifestation of 
coronary artery disease (CAD). Angina pectoris occurs as a result of an 
imbalance between myocardial perfusion and the demands of the myocardium. 
Elevated heart rate (HR) is an important pathophysiological variable that 
increases myocardial oxygen demand, and also limits tissue perfusion by reducing 
the duration of diastole during which most myocardial perfusion occurs. Elevated 
resting HR represents a significant predictor of all-cause and cardiovascular 
mortality in the general population and patients with cardiovascular disease 
(CVD) because it assists the progression of CVD through the development of 
atherosclerosis, plaque destabilization, and initiation of arrhythmias. Since 
β-blockers have been found to reduce HR, therefore, they are currently viewed as 
the first line therapy for CSAP and are associated with an improved prognosis 
after acute myocardial infarction (AMI) or congestive heart failure (CHF). The 
classical treatments for HR reduction have shown negative aspects, such as 
β-blockers therapy which exerts negative effects on regional myocardial blood 
flow and function when HR reduction is eliminated by atrial pacing. Calcium 
channel antagonists functionally antagonize coronary vasoconstriction mediated 
through α-adrenoreceptors, and are thus devoid of this undesired effect, but the 
compounds are nevertheless negative inotrope. Ivabradine (IVA), a pure HR 
lowering drug, reduces the demand of myocardial oxygen during exercise, 
contributes to the restoration of oxygen balance and is therefore beneficial in 
chronic CVD. No relevant negative effects have been observed on cardiac 
conduction, contractility, relaxation, repolarization or blood pressure (BP). 
Beneficial effects of IVA have been noticed in CSAP and CHF, with optimal 
tolerability profile due to selective interaction with I(f) channel of sino 
atrial node cells. More recently, IVA has been highly recommended to be used in 
patients with CAD in association with β-blockers. This review highlights the 
importance of IVA in the treatment of ischemic heart disease.