Key result
Landiolol produced a significantly smaller heart rate reduction at 24 hours in patients with atrial flutter/tachycardia compared to atrial fibrillation (-16.1% vs -31.3%; P<0.02).
Why the study?
The impact of the specific type of atrial tachyarrhythmia on the effectiveness of landiolol in patients with reduced left ventricular function is uncertain.
Does landiolol effectively control heart rate in patients with acute decompensated heart failure and atrial flutter/atrial tachycardia compared to atrial fibrillation?
Cohort (n=77)
Does landiolol effectively control heart rate in patients with acute decompensated heart failure and atrial flutter/atrial tachycardia compared to atrial fibrillation?
Absolute Event Rate: -16.1% vs -31.3%
p-value: p=<0.02
Landiolol is highly effective for heart rate control in patients with atrial fibrillation and LV dysfunction, but largely ineffective for those with atrial flutter or atrial tachycardia, who frequently require alternative treatments.
Landiolol may fail to control HR in most AFl/AT patients with LV dysfunction; leaves open differential efficacy by arrhythmia type pending prospective confirmation.
BACKGROUND: -selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and left ventricular (LV) dysfunction. The impact of the type of atrial tachyarrhythmias on the effectiveness of landiolol is uncertain. We evaluated the efficacy and safety of landiolol on tachycardiac atrial fibrillation (AF) and tachycardiac atrial flutter/atrial tachycardia (AFl/AT) in patients with reduced LV function. METHODS AND RESULTS: Seventy-seven patients treated with landiolol were retrospectively analyzed. There were no significant differences in the baseline characteristics between the AF group (n=65) and AFl/AT group (n=12). Despite a higher dosage, the %change in HR from baseline to 12 and 24 h was only -10.2±12.7% and -16.1±19.4% in the AFl/AT group, while it was -28.3±13.2% and -31.3±11.3% in the AF group (P<0.02), respectively. The prevalence of the responders to landiolol treatment was much greater in the AF group than in the AFl/AT group (P<0.001). Alternative treatments such as i.v. amiodarone and electrical cardioversion were required in 83% of the AFl/AT patients. CONCLUSIONS: Landiolol was ineffective in the majority of AFl/AT patients. An alternative management to prevent any worsening of heart failure might be considered in those patients.
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Oka et al. (2019) conducted a cohort in Atrial tachyarrhythmias with left ventricular dysfunction (n=77). Atrial flutter/atrial tachycardia (AFl/AT) vs. Atrial fibrillation (AF) was evaluated on % change in heart rate from baseline to 24 h (p=<0.02). Landiolol produced a significantly smaller heart rate reduction at 24 hours in patients with atrial flutter/tachycardia compared to atrial fibrillation (-16.1% vs -31.3%; P<0.02).
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