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

Masaya Shinohara; Ryou Wada; Kensuke Yano; Katsuya Akitsu; Hideki Koike; Toshio Kinoshita; Takeya Suzuki; Tadashi Fujino; Takanori Ikeda

doi:10.1536/ihj.20-256

September 11, 2020International Heart JournalOpen Access

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

View Full Paper

Ask AI

Bookmark

Share

Why the study?

Clinical experience with landiolol in patients with AF and severely depressed LV function is limited.

Does intravenous landiolol improve heart rate control compared to intravenous digoxin in patients with atrial fibrillation and severely depressed left ventricular function (LVEF ≤ 25%)?

Structured PICO

Does intravenous landiolol improve heart rate control compared to intravenous digoxin in patients with atrial fibrillation and severely depressed left ventricular function (LVEF ≤ 25%)?

P

Population

53 patients with atrial fibrillation tachycardias and severely depressed left ventricular function (LVEF ≤ 25%)

I

Intervention

Intravenous landiolol (dose adjusted between 0.5 and 10 μg/kg/minute)

C

Comparator

Intravenous digoxin

O

Outcome

Responder rate at 24 hours (defined as a decrease in the heart rate of ≤ 110/minute and decreased by ≥ 20% from baseline)surrogate

Intravenous landiolol is more effective than digoxin for achieving rapid heart rate control in atrial fibrillation patients with severely depressed LVEF, though it requires careful hemodynamic monitoring due to its blood pressure-lowering effects.

Implication

May support landiolol preference in this cohort; leaves open randomized confirmation for AF with LVEF ≤25%.

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.