Key result
Landiolol continuous infusion with a preceding bolus achieved heart rate control in 40% of patients compared to 60% with continuous infusion alone, showing no significant difference (P=0.66).
Why the study?
The suitability of landiolol for treating atrial fibrillation or atrial flutter in Caucasian patients had not previously been investigated.
Does landiolol continuous infusion with or without a bolus reduce heart rate in Caucasian patients with atrial fibrillation/atrial flutter?
RCT (n=20)
Open-label
No
Does landiolol continuous infusion with or without a bolus reduce heart rate in Caucasian patients with atrial fibrillation/atrial flutter?
Absolute Event Rate: 40% vs 60%
p-value: p=0.66
Continuous infusion of landiolol (40 µg/kg/min) without a preceding bolus is suitable and safe for acute heart rate control in Caucasian patients with tachycardic AF/AFL.
Landiolol CI without bolus may aid acute rate control in Caucasian AF/AFL; leaves open whether bolus addition improves outcomes.
BACKGROUND: We investigated for the first time the suitability of landiolol, an ultra-short-acting β1-specific β-blocker, for the treatment of atrial fibrillation/atrial flutter (AF/AFL) in Caucasian patients. METHODS AND RESULTS: The 20 study patients received landiolol as a continuous infusion (starting dose 40 µg/kg/min) with (B+CI) or without (CI) a preceding bolus dose (100 µg/kg/min administered over 1 min) in a prospective open-label study. The primary endpoint was the proportion of patients with sustained heart rate (HR) reduction ≥20% or to <90 beats/min within 16 min of starting the CI. Secondary endpoints were the pharmacodynamics, pharmacokinetics, AF/AFL symptoms, safety and tolerability of landiolol. At 16 min, HR was reduced in all patients treated with landiolol. The primary endpoint was met by 60% of patients in the CI group and 40% in the B+CI group without a significant group difference. Overall reduction of AF/AFL symptoms at 16 min was 72%. Safety and local tolerability of landiolol were excellent, and no serious adverse events occurred. CONCLUSIONS: Continuous infusion of landiolol with a starting dose of 40 µg/kg/min is suitable for the acute treatment of tachycardic AF/AFL in Caucasian patients. Administration of a preceding bolus seems unnecessary.
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Stix et al. (2019) conducted an RCT in Atrial fibrillation and atrial flutter (n=20). Landiolol continuous infusion with bolus (B+CI) vs. Landiolol continuous infusion without bolus (CI) was evaluated on Proportion of patients with sustained heart rate (HR) reduction ≥ 20% or to <90 beats/min within 16 min of starting the continuous infusion (p=0.66). Landiolol continuous infusion with a preceding bolus achieved heart rate control in 40% of patients compared to 60% with continuous infusion alone, showing no significant difference (P=0.66).
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