title: Urgent management of rapid heart rate in patients with atrial fibrillation/flutter and left ventricular dysfunction: comparison of the ultra-short-acting β1-selective blocker landiolol with digoxin (J-Land Study).
abstract: BACKGROUND
  A rapid heart rate (HR) during atrial fibrillation (AF) and atrial flutter (AFL) in left ventricular (LV) dysfunction often impairs cardiac performance. The J-Land study was conducted to compare the efficacy and safety of landiolol, an ultra-short-acting β-blocker, with those of digoxin for swift control of tachycardia in AF/AFL in patients with LV dysfunction.
  
  
  RESULTS
  The 200 patients with AF/AFL, HR ≥120beats/min, and LV ejection fraction 25-50% were randomized to receive either landiolol (n=93) or digoxin (n=107). Successful HR control was defined as ≥20% reduction in HR together with HR <110beats/min at 2h after starting intravenous administration of landiolol or digoxin. The dose of landiolol was adjusted in the range of 1-10µg·kg(-1)·min(-1) according to the patient's condition. The mean HR at baseline was 138.2±15.7 and 138.0±15.0beats/min in the landiolol and digoxin groups, respectively. Successful HR control was achieved in 48.0% of patients treated with landiolol and in 13.9% of patients treated with digoxin (P<0.0001). Serious adverse events were reported in 2 and 3 patients in each group, respectively.
  
  
  CONCLUSIONS
  Landiolol was more effective for controlling rapid HR than digoxin in AF/AFL patients with LV dysfunction, and could be considered as a therapeutic option in this clinical setting.
authors.affiliation: Jichi Medical University, Shimotsuke, Japan.
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Atarashi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aiba
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kitakaze
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Takanori
authors.initials: T
authors.lastname: Ikeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Imai
authors.forename: Takashi
authors.initials: T
authors.lastname: Daimon
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Fujino
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Nagano
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Okamura
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hori
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology*; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000494:pharmacology*; D001282:Atrial Flutter / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004077:Digoxin / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000009:adverse effects / Q000494:pharmacology*; D011446:Prospective Studies; D013610:Tachycardia / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D014508:Urea / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D000889:Anti-Arrhythmia Agents; D009025:Morpholines; C077049:landiolol; D004077:Digoxin; D014508:Urea