title: An Experience of Landiolol Use for an Advanced Heart Failure Patient With Severe Hypotension.
abstract: Tachyarrhythmias such as atrial fibrillation (AF) or atrial flutter (AFL) sometimes invoke life-threatening collapse of hemodynamics in patients with severe heart failure. Recently, landiolol, an ultra-short acting β1-selective antagonist, has been reported to be safe and useful for the treatment of supraventricular tachyarrhythmias with reduced left ventricular function. Here we report a case of advanced heart failure with severe hypotension who was treated successfully by landiolol for rapid AF. The patient was a 20-year old male with dilated cardiomyopathy. He presented with low output syndrome in spite of optimal medical therapy and was referred to our department to consider ventricular assist device implantation and heart transplantation. Soon after admission, he developed rapid atrial fibrillation at 180 beats per minute (bpm) followed by severe hypotension and liver enzyme elevation. Low dose landiolol at 2 μg/kg/minute was started because digoxin was not effective. After landiolol administration, his heart rate decreased to 110 bpm, and finally returned to sinus rhythm without hemodynamic deterioration. Intra-aortic balloon pumping was inserted soon after sinus recovery and he was discharged successfully with an implantable left ventricular assist device.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nitta
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Miyoko
authors.initials: M
authors.lastname: Endo
authors.forename: Eisuke
authors.initials: E
authors.lastname: Amiya
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inaba
authors.forename: Hisataka
authors.initials: H
authors.lastname: Maki
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage / Q000493:pharmacokinetics; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D001682:Biological Availability; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology; D007423:Intra-Aortic Balloon Pumping / Q000379:methods; D008297:Male; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D009025:Morpholines / Q000008:administration & dosage / Q000493:pharmacokinetics; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014508:Urea / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D009025:Morpholines; C077049:landiolol; D014508:Urea