Successful Ivabradine Use Throughout Pregnancy for Postural Orthostatic Tachycardia Syndrome: A Case Report with Reassuring Maternal-Fetal Outcomes

We report on a 35-year-old gravida 2 para 1 woman with long-COVID postural orthostatic tachycardia syndrome (POTS) who continued all pharmacologic therapies from preconception through delivery, including ivabradine, a medication contraindicated in pregnancy because of preclinical embryotoxicity and teratogenicity. Serial fetal assessments including growth studies, fetal Dopplers, and nonstress tests remained normal throughout gestation without evidence of fetal bradycardia, arrhythmia, or structural abnormalities. Delivery at 38 weeks 5 days’ gestation resulted in a healthy female neonate. This case illustrates successful use of off-label ivabradine in pregnancy with reassuring maternal–fetal outcomes under close obstetric-cardiology supervision.