A multicentre observational study on landiolol use, efficacy, and safety in European patients with supraventricular arrhythmia (Landi-UP)

AIMS: Landiolol is an ultrashort-acting, highly cardio-selective beta1-adrenergic receptor blocker used for short-term control of tachyarrhythmias. While its real-world use has been described in Japan, data from European clinical practice are lacking. This study aimed to collect real-world data on landiolol use, effectiveness, and safety across diverse clinical settings in Europe. METHODS AND RESULTS: This multicentre, observational study included adult patients with supraventricular arrhythmias treated with landiolol. Patient characteristics, drug utilization patterns, efficacy, and safety were assessed. In total, 450 patients were enrolled and 449 were analysed (median age: 72 years, IQR 63-78) from 17 sites across 8 European countries. Most patients (73.1%) received landiolol for atrial fibrillation. The median (IQR) duration of infusion was 8.9 (2.3-34.0) h, with starting, minimum, and maximum doses of 5.3 (2.5-10.0), 4.0 (1.7-10), and 10.0 (6.0-30.0) µg/kg/min, respectively. Heart rate (HR) control, defined as HR ≤110 b.p.m. or a reduction of >20% from baseline, was achieved in 74.2% of patients within 4 h after treatment discontinuation, with 36.9% of arrhythmia patients restoring sinus rhythm. Blood pressure (BP) remained stable throughout treatment. A total of 123 adverse events and 113 major adverse cardiac events were reported, none of which were related to landiolol. CONCLUSION: In European clinical practice, landiolol dosing adhered to product information recommendations. Landiolol was effective in controlling HR, with minimal impact on BP. The treatment was well tolerated, and no new safety signals were identified. These findings support the efficacy and safety of landiolol across diverse clinical settings in Europe.