Key result
Landiolol significantly lowered the incidence of new-onset arrhythmias compared to control treatment in critically ill patients (OR 0.44; 95% CI 0.23 to 0.82; p=0.01).
Why the study?
Critically ill patients frequently experience tachyarrhythmias, and ultrashort-acting beta-blockers such as landiolol are commonly used in intensive care units, prompting evaluation of its efficacy.
Does landiolol reduce new-onset arrhythmias in critically ill patients?
Meta-Analysis (n=836)
Does landiolol reduce new-onset arrhythmias in critically ill patients?
Odds Ratio: 0.44 (95% CI 0.23–0.82)
p-value: p=0.01
In critically ill patients, landiolol significantly reduces new-onset arrhythmias and heart rate, though it does not improve mortality and may prolong ICU stay.
Background Patients with critical illnesses frequently experience tachyarrhythmias as a result of excessive sympathetic hyperactivity and high levels of inflammatory cytokines. Ultrashort‐acting β ‐blockers like landiolol are commonly utilized in intensive care units (ICUs) because of their unique features. Methods Electronic databases (Cochrane Library, PubMed, Web of Science, and Embase) were searched for randomized controlled trials (RCTs) from inception to September 1, 2025 assessing the efficacy of landiolol in critically ill patients. The primary outcome was new‐onset arrhythmias. All‐cause mortality, heart rate (HR), length of ICU and hospital stay, and need for norepinephrine following landiolol therapy were the secondary outcomes. Trial sequential analysis (TSA) was performed to further evaluate the robustness of findings. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Results Nine studies totaling 836 patients were included. Overall, our meta‐analysis exhibited that landiolol might considerably lower the incidence of new‐onset arrhythmias when compared to the control treatment (9 studies [836 patients]; odds ratio [OR], 0.44; 95% confidence interval [CI] 0.23 to 0.82; p = 0.01), and TSA agreed with this finding. We also observed that landiolol could reduce HR (mean difference [MD], −6.41, 95% CI, −8.63 to −4.18, p < 0.001). However, there was no considerable decrease in requirement of norepinephrine dose (MD, 0.04, 95% CI, −0.01 to 0.09, p = 0.11), length of hospital stay (MD, −0.87, 95% CI, −7.40 to 5.65, p = 0.79), or all‐cause mortality (OR, 1.10, 95% CI, 0.62 to 1.96, p = 0.75). Additionally, the length of ICU stay in the landiolol group was longer than that in the control group (MD, 0.19; 95% CI 0.01 to 0.37; p = 0.03). Conclusion New‐onset arrhythmias and HR were significantly reduced in critical illness patients receiving landiolol.
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Kuang et al. (2025) conducted a meta-analysis in Critical illness (n=836). Landiolol vs. Control treatment was evaluated on New-onset arrhythmias (OR 0.44, 95% CI 0.23 to 0.82, p=0.01). Landiolol significantly lowered the incidence of new-onset arrhythmias compared to control treatment in critically ill patients (OR 0.44; 95% CI 0.23 to 0.82; p=0.01).
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