title: Impacts of patient characteristics on the effectiveness of landiolol in AF/AFL patients complicated with LV dysfunction: Subgroup analysis of the J-Land study.
abstract: BACKGROUND
  Results from the multicenter trial (J-Land study) of landiolol versus digoxin in atrial fibrillation (AF) and atrial flutter (AFL) patients with left ventricular (LV) dysfunction revealed that landiolol was more effective for controlling rapid HR than digoxin. The subgroup analysis for patient characteristics was conducted to evaluate the impact on the efficacy and safety of landiolol compared with digoxin.
  
  
  METHODS
  Two hundred patients with AF/AFL, heart rate (HR) ≥ 120 beats/min, and LV ejection fraction (LVEF) 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 < 110 beats/min at 2 h after starting intravenous administration of landiolol or digoxin. The subgroup analysis for patient characteristics was to evaluate the impact on the effectiveness of landiolol in AF/AFL patients complicated with LV dysfunction.
  
  
  RESULTS
  The efficacy in patients with NYHA class III/NYHA class IV was 52.3%/35.3% in landiolol, and 13.8%/9.1% in digoxin (p < 0.001 and p = 0.172), lower LVEF (25-35%)/higher LVEF (35-50%) was 45.7%/51.1% in landiolol, and 14.0%/12.7% in digoxin (p < 0.001 and p < 0.001), CKD stage 1 (90 < eGFR)/CKD stage 2 (60 ≤ eGFR < 90)/CKD stage 3 (30 ≤ eGFR < 60)/CKD stage 4 (15 ≤ eGFR < 30) was 66.7%/59.1%/39.6%/66.7% in landiolol, and 0%/13.8%/17.0%/0% in digoxin (p = 0.003, p < 0.001, p = 0.015 and p = 0.040).
  
  
  CONCLUSIONS
  This subgroup analysis indicated that landiolol was more useful, regardless of patient characteristics, as compared with digoxin in AF/AFL patients complicated with LV dysfunction. Particularly, in patients with impaired renal function, landiolol should be preferred for the purpose of acute rate control of AF/AFL tachycardia.
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, kinugawa-tky@umin.ac.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
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: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001282:Atrial Flutter / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004077:Digoxin / Q000008:administration & dosage / Q000009:adverse effects; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage / Q000009:adverse effects; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D014508:Urea / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology
chemical_list: D000889:Anti-Arrhythmia Agents; D009025:Morpholines; C077049:landiolol; D004077:Digoxin; D014508:Urea