title: A low-dose β1-blocker effectively and safely slows the heart rate in patients with acute decompensated heart failure and rapid atrial fibrillation.
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.
authors.affiliation: Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Wakako
authors.initials: W
authors.lastname: Murakami
authors.forename: Takeki
authors.initials: T
authors.lastname: Myoren
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tateishi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okuda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Doi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nao
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Wada
authors.forename: Masunori
authors.initials: M
authors.lastname: Matsuzaki
authors.forename: Masafumi
authors.initials: M
authors.lastname: Yano
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D009025:Morpholines / Q000008:administration & dosage*; D014508:Urea / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000319:Adrenergic beta-Antagonists; D009025:Morpholines; C077049:landiolol; D014508:Urea