A Low-Dose β1-Blocker Effectively and Safely Slows the Heart Rate in Patients with Acute Decompensated Heart Failure and Rapid Atrial Fibrillation

Shigeki Kobayashi; Wakako Murakami; Takeki Myoren; Hiroki Tateishi; Shinichi Okuda; Masahiro Doi; Tomoko Nao; Yasuaki Wada; Masunori Matsuzaki; Masafumi Yano

doi:10.1159/000355312

November 26, 2013Cardiology

A Low-Dose β1-Blocker Effectively and Safely Slows the Heart Rate in Patients with Acute Decompensated Heart Failure and Rapid Atrial Fibrillation

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Why the study?

Does continuous intravenous infusion of low-dose landiolol reduce heart rate in patients with acute decompensated heart failure and rapid atrial fibrillation?

Structured PICO

Does continuous intravenous infusion of low-dose landiolol reduce heart rate in patients with acute decompensated heart failure and rapid atrial fibrillation?

P

Population

23 patients with acute decompensated heart failure (ADHF) and rapid atrial fibrillation (HR ≥120 beats/min, NYHA class III-IV), including systolic heart failure (n=12) and diastolic heart failure (n=11), receiving conventional therapy with diuretics, vasodilators, and/or low-dose inotropes.

I

Intervention

Continuous intravenous infusion of low-dose landiolol (1.0-2.0 µg/kg/min) for 24 hours.

O

Outcome

Heart rate reduction and blood pressure changes at 2 hours and over 24 hours.surrogate

Low-dose landiolol safely and effectively reduces heart rate in patients with acute decompensated heart failure and rapid atrial fibrillation without causing hypotension.

Implication

Low-dose landiolol was associated with HR reduction without hypotension in acute decompensated HF with AF; hypothesis-generating and requires RCT confirmation.

Abstract

OBJECTIVE: Recently, we reported that low-dose landiolol (1.5 µg·kg(-1)·min(-1)), an ultra-short-acting β-blocker, safely decreased the heart rate (HR) in patients with acute decompensated heart failure (ADHF) and sinus tachycardia, thereby improving cardiac function. We investigated whether low-dose landiolol effectively decreased the HR in ADHF patients with rapid atrial fibrillation (AF). METHODS: We enrolled 23 ADHF patients with rapid AF (HR ≥120 beats·min(-1) and New York Heart Association class III-IV) and systolic heart failure (SHF: n = 12) or diastolic heart failure (DHF: n = 11) who received conventional therapy with diuretics, vasodilators, and/or low-dose inotropes. They were administered continuous intravenous infusion of low-dose landiolol (1.0-2.0 µg·kg(-1)·min(-1)), and their electrocardiograms and blood pressures were monitored for 24 h thereafter. RESULTS: Two hours after starting landiolol, the HR was reduced significantly (22%), without a reduction in blood pressure, and remained constant thereafter. The HR reduction 2 h after landiolol administration was significantly greater in the DHF group than in the SHF group. No incidence of hypotension was recorded. CONCLUSIONS: Digitalis or amiodarone is currently recommended for HR control in ADHF patients with rapid AF. Our results showed that continuous infusion of low-dose landiolol may also be useful as first-line therapy in these patients.