Practical applicability of landiolol, an ultra-short-acting β1-selective blocker, for rapid atrial and ventricular tachyarrhythmias with left ventricular dysfunction.

Abstract

BACKGROUND:

Landiolol effectively controls rapid heart rate in atrial fibrillation or flutter (AF/AFL) patients with left ventricular (LV) dysfunction. However, predicting landiolol Responders and Non-Responders and patients who will experience adverse effects remains a challenge. The aim of this study was to clarify the potential applicability of landiolol for rapid AF/AFL and refractory ventricular tachyarrhythmias (VTs) in patients with heart failure.

METHODS:

A total of 39 patients with AF/AFL with ventricular response ≥120 bpm and 12 VTs were retrospectively enrolled. Landiolol Responders for rapid AF/AFL were defined as patients whose ventricular response was suppressed to less than 110 bpm or decreased by ≥20% from the initial heart rate after administration of landiolol. Responders for VTs were defined as patients with no recurrent VTs during the 24 h after the initiation of landiolol.

RESULTS:

For AF/AFL, 29 patients (74%) were Responders. In nine patients (31%), AF was spontaneously terminated after starting landiolol. Eight Non-Responders (80%) needed to have AF terminated by cardioversion. Left ventricular ejection fraction (LVEF) at baseline was significantly associated with landiolol efficacy. For VTs, seven patients (58%) were Responders, and smaller LV diastolic and systolic diameters were associated with landiolol efficacy. Hypotension after landiolol treatment occurred in 5 of 51 patients, and lower LV systolic function was associated with the development of adverse events.

CONCLUSIONS:

Landiolol is effective in patients with heart failure not only due to rapid AF/AFL but also due to VTs. However, preserved LVEF is important for efficacy and safety in landiolol treatment.

• Authors: Yuko Wada, Takeshi Aiba, Yasuyuki Tsujita, Hideki Itoh, Mitsuru Wada, Ikutaro Nakajima, Kohei Ishibashi, Hideo Okamura, Koji Miyamoto, Takashi Noda, Yasuo Sugano, Hideaki Kanzaki, Toshihisa Anzai, Kengo Kusano, Satoshi Yasuda, Minoru Horie, Hisao Ogawa
• Journal: Journal of arrhythmia (J Arrhythm) Vol. 32 Issue 2 Pg. 82-8 (Apr 2016) ISSN: 1880-4276 [Print] Japan
• PMID: 27092187 (Publication Type: Journal Article)