title: Effects of landiolol on refractory tachyarrhythmia after total cavopulmonary connection: a retrospective, observational, cohort study.
abstract: The onset of tachyarrhythmia after the Fontan procedure (total cavopulmonary connection; TCPC) should be considered a medical emergency. Landiolol is an ultra-short-acting β1-selective blocker whose effect on tachyarrhythmia after TCPC is unclear. We evaluated the efficacy and safety of landiolol for tachyarrhythmia after TCPC. Consecutive patients undergoing TCPC were enrolled from January 2007 to December 2011. Of 435 pediatric open heart surgeries, 28 patients underwent TCPC. Of the 28 patients, 13 were treated with landiolol for critical tachyarrhythmia. Excluding three patients who received landiolol during surgery, we investigated the remaining 10 patients and statistical analysis was performed without a 10-year-old patient as outlier. The median age was 4.08 years. The subjects comprised five patients with sinus tachycardia, four with junctional ectopic tachycardia and one with paroxysmal supraventricular tachycardia. The initial dose was 4.7 ± 2.3 μg/kg/min, without a loading dose. Landiolol reduced the heart rate from 151.8 ± 23.2 at the start to 132.9 ± 20.0 at 1 h and 126.1 ± 24.9 at 2 h (P < 0.01 and P < 0.01, respectively), without blood pressure decrease (P = 0.235). Landiolol was effective in treating critical tachyarrhythmia without hemodynamic deterioration. We believe that landiolol is a promising option for postoperative tachyarrhythmia after the Fontan procedure.
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Miyake
authors.affiliation: Department of Anesthesiology, Aichi Medical University School of Medicine, 1-1 Karimata Yazako Nagakute, Aichi, 480-1195, Japan. fujita.yoshihito.823@mail.aichi-med-u.ac.jp.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Fujita
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Saya
authors.initials: S
authors.lastname: Yoshizawa
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Tomita
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyazu
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sento
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yoshimura
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sobue
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D009025:Morpholines / Q000627:therapeutic use*; D011184:Postoperative Period; D011651:Pulmonary Artery; D012189:Retrospective Studies; D013610:Tachycardia / Q000188:drug therapy*; D013617:Tachycardia, Supraventricular / Q000188:drug therapy*; D014508:Urea / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D009025:Morpholines; C077049:landiolol; D014508:Urea
keywords: Fontan operation; Landiolol; TCPC; Tachyarrhythmia; Tachycardia; Total cavopulmonary connection; β1-Selective blocker