Landiolol for refractory tachyarrhythmias in the intensive care unit: case reports

Figures

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  Figure 1. Electrocardiograms (25 mm/s) of the patient with septic shock caused by urosepsis. The patient developed tachycardic atrial fibrillation with a rate of up to 140/min (A). Five hours after the initiation of continous landiolol infusion, the patient converted to sinus rhythm with a reduction of heart rate to 95/min (B).

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  Figure 2. Detailed clinical course of the first 24 h after intensive care unit admission of the patient with urosepsis. During continuous norepinephrine treatment, the patient developed tachycardic atrial fibrillation which resulted in hypotension requiring an increase in norepinephrine dose. Addition and up titration of continuous landiolol infusion had no effects on mean arterial pressure, while heart rate was decreased und ultimately lead to conversion to sinus rhythm after 5 h of treatment.

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  Figure 3. Apical four-chamber view of the severely dilated left ventricle of the patient with advanced nonischaemic cardiomyopathy and a left ventricular ejection fraction of ∼10% (A). Electrocardiogram (25 mm/s) of the ventricular tachycardia with a rate of 145/min (B).

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  Movie 1. Apical four-chamber view (A) and apical three-chamber view (B) of the patient with advanced nonischaemic cardiomyopathy.

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  Figure 4. Detailed clinical course of the patient with advanced nonischaemic cardiomyopathy and electrical storm. The patient received 23 implantable cardioverter-defibrillator shocks before he was transferred to our centre. Detailed timing of shocks by cardiac resynchronization therapy-defibrillator interrogation was only available for shock number 8 and later shocks because of limited memory capacity of the device. After addition of landiolol to amiodarone treatment, a rhythmological stabilization with a reduction of ventricular tachycardia events could be achieved. Of note, despite a left ventricular ejection fraction of ∼10%, landiolol treatment did not result in a significant reduction of mean arterial pressure. Red dots and numbers denote implantable cardioverter-defibrillator shocks.