title: Effects of landiolol hydrochloride on intractable tachyarrhythmia after pediatric cardiac surgery.
abstract: BACKGROUND
  While β-blockers can be effective in controlling tachyarrhythmias after pediatric cardiac surgery, a negative inotropic influence sometimes complicates their use. Landiolol hydrochloride is a novel, ultra-short-acting β-blocker recently developed in Japan. The drug has higher β1:β2 selectivity ratio and a less negative inotropic effect. This study retrospectively evaluates the efficacy and safety of landiolol in the management of tachyarrhythmias after pediatric cardiac surgery.
  
  
  METHODS
  A retrospective analysis was performed on 312 consecutive patients undergoing surgery for congenital heart disease. Twelve patients were treated with landiolol for critical tachyarrhythmia. The mean age of patients was 28.7 ± 10.6 months. Five junctional ectopic tachycardia, 2 atrial flutters, 1 paroxysmal supraventricular tachycardia, 1 atrial fibrillation, 1 atrioventricular reciprocating tachycardia with Wolff-Parkinson-White syndrome and 2 excessive sinus tachycardia were treated.
  
  
  RESULTS
  The mean loading and maintenance doses were 11.3 ± 4.0 and 6.8 ± 0.9 μg/kg per minute, respectively. Rate control was achieved in all patients. Landiolol reduced the heart rate from 169.7 ± 11.4 to 127.7 ± 7.5 beats per minute (p < 0.05) while blood pressure did not significantly change. Tachyarrhythmias were converted to sinus rhythm in 70.0% of the cases and the average time needed to achieve heart rate reduction was 2.3 ± 0.5 hours.
  
  
  CONCLUSIONS
  Landiolol was efficacious in treating tachyarrhythmia in pediatric cardiac surgery. The desired negative chronotropic effect was achieved without significant hemodynamic compromise. The ultra-short half-life of landiolol provided rapid dose manipulation. This study suggests that landiolol is a promising option for the management of postoperative tachyarrhythmias in pediatric patients.
authors.affiliation: Department of Cardiovascular Surgery, University of Tsukuba, Ibaraki, Japan. chiho-t@md.tsukuba.ac.jp
authors.forename: Chiho
authors.initials: C
authors.lastname: Tokunaga
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hiramatsu
authors.forename: Shinya
authors.initials: S
authors.lastname: Kanemoto
authors.forename: Miho
authors.initials: M
authors.lastname: Takahashi-Igari
authors.forename: Masakazu
authors.initials: M
authors.lastname: Abe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Horigome
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Sakakibara
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009025:Morpholines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D013610:Tachycardia / Q000188:drug therapy*; D014508:Urea / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D009025:Morpholines; C077049:landiolol; D014508:Urea