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

Q: What are the key findings of this study?

Landiolol effectively controlled rapid heart rate, achieving responder criteria in 74% of patients with rapid atrial tachyarrhythmias and 58% of patients with refractory ventricular tachyarrhythmias.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with rapid atrial or ventricular tachyarrhythmias (n=51). Intervention: Landiolol. Primary outcome: Responder rate (suppression of ventricular response to <110 bpm or ≥20% decrease from initial heart rate for AF/AFL; no recurrent VTs during 24 hours for VTs).

Q: What does this research mean for the field?

Landiolol effectively achieves rate or rhythm control in 74% of patients with rapid atrial tachyarrhythmias and 58% of patients with refractory ventricular tachyarrhythmias complicated by heart failure, with efficacy and safety linked to baseline left ventricular function. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

doi:10.1016/j.joa.2015.09.002

November 2, 2015Journal of ArrhythmiaOpen Access

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

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Key result

Landiolol controls rapid heart rates in ~74% of patients with atrial tachyarrhythmias.

n=51

Why the study?

Does landiolol reduce heart rate and prevent recurrent arrhythmias in patients with heart failure and rapid atrial or ventricular tachyarrhythmias?

Study Design

Type

Cohort (n=51)

Multicenter

Yes

Structured PICO

Does landiolol reduce heart rate and prevent recurrent arrhythmias in patients with heart failure and rapid atrial or ventricular tachyarrhythmias?

P

Population

51 patients with heart failure and either rapid atrial tachyarrhythmias (ventricular response ≥120 bpm) or refractory ventricular tachyarrhythmias, retrospectively evaluated for landiolol efficacy.

E

Exposure

Landiolol intravenous infusion, initiated at 1 μg/min/kg and titrated up to 10 μg/min/kg

O

Outcome

Responder status (for AF/AFL: ventricular response <110 bpm or ≥20% reduction from baseline; for VTs: no recurrent VTs for 24 h after landiolol initiation)surrogate

Landiolol offers an effective ultra-short-acting therapeutic option for controlling heart rate in severe heart failure patients with rapid tachyarrhythmias, though those with deeply reduced ejection fraction are at higher risk of non-response and adverse events.

Limitations

Retrospective and nonrandomized design
Small sample size at two cardiovascular hospitals
Short follow-up period
No control group or direct comparison with conventional therapy
Retrospective and nonrandomized
Small sample size
Did not compare landiolol with digoxin or a control

Implication

Landiolol may aid rate control in HF tachyarrhythmias with EF caution; leaves open randomized confirmation.

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.

Discussion

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Cite This Study

Wada et al. (2015) conducted a cohort in Heart failure with rapid atrial or ventricular tachyarrhythmias (n=51). Landiolol was evaluated on Responder rate (suppression of ventricular response to <110 bpm or ≥20% decrease from initial heart rate for AF/AFL; no recurrent VTs during 24 hours for VTs). Landiolol effectively controlled rapid heart rate, achieving responder criteria in 74% of patients with rapid atrial tachyarrhythmias and 58% of patients with refractory ventricular tachyarrhythmias.

synapsesocial.com/papers/6a208084e1fa5be4a5f41e8e https://doi.org/10.1016/j.joa.2015.09.002