Comparison of Landiolol and Digoxin as an Intravenous Drug for Controlling the Heart Rate in Patients with Atrial Fibrillation and Severely Depressed Left Ventricular Function.

Abstract

Clinical experience with landiolol use in patients with atrial fibrillation (AF) and a severely depressed left ventricular (LV) function is limited. We compared the efficacy and safety of landiolol with that of digoxin as an intravenous drug in controlling the heart rate (HR) during AF associated with a very low LV ejection fraction (LVEF).We retrospectively analyzed 53 patients treated with landiolol (n = 34) or digoxin (n = 19) for AF tachycardias with an LVEF ≤ 25. The landiolol dose was adjusted between 0.5 and 10 μg/kg/minute according to the patient's condition. The response to treatment was defined as a decrease in the HR of ≤ 110/minute, and that decreased by ≥ 20% from baseline.There were no significant differences between the two groups regarding the clinical characteristics. The responder rate to landiolol at 24 hours was significantly higher than that to digoxin (71.0% versus 41.2%; odds ratio: 4.65, 95% confidence interval: 1.47-31.0, P = 0.048). The percent decrease in the HR from baseline at 1, 2, 12, and 24 hours was greater in the landiolol group than in the digoxin group (P < 0.01, P = 0.071, P = 0.036, and P = 0.016, respectively). The systolic blood pressure (SBP) from baseline within 24 hours after administering landiolol was significantly reduced, whereas digoxin did not decrease the SBP over time. Hypotension (< 80 mmHg) occurred in two patients in the landiolol group and 0 in the digoxin group (P = 0.53).Landiolol could be more effective in controlling the AF HR than digoxin even in patients with severely depressed LV function. However, careful hemodynamic monitoring is necessary when administering landiolol.

• Authors: Masaya Shinohara, Ryou Wada, Kensuke Yano, Katsuya Akitsu, Hideki Koike, Toshio Kinoshita, Takeya Suzuki, Tadashi Fujino, Takanori Ikeda
• Journal: International heart journal (Int Heart J) Vol. 61 Issue 5 Pg. 944-950 (Sep 29 2020) ISSN: 1349-3299 [Electronic] Japan
• PMID: 32921677 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-Arrhythmia Agents
• Morpholines
• landiolol
• Digoxin
• Urea

Topics

• Administration, Intravenous
• Aged
• Aged, 80 and over
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (drug therapy, etiology, physiopathology)
• Blood Pressure
• Digoxin (therapeutic use)
• Female
• Heart Failure (complications, physiopathology)
• Heart Rate
• Humans
• Male
• Middle Aged
• Morpholines (therapeutic use)
• Retrospective Studies
• Severity of Illness Index
• Stroke Volume
• Tachycardia (drug therapy, etiology, physiopathology)
• Treatment Outcome
• Urea (analogs & derivatives, therapeutic use)
• Ventricular Dysfunction, Left (complications, physiopathology)