Practical applicability of landiolol, an ultra-short-acting β1-selective blocker, for rapid atrial and ventricular tachyarrhythmias with left ventricular dysfunction.
BACKGROUND
Landiolol effectively controls rapid heart rate in atrial fibrillation or flutter (AF/AFL) patients with left ventricular (LV) dysfunction. However, predicting landiolol Responders and Non-Responders and patients who will experience adverse effects remains a challenge. The aim of this study was to clarify the potential applicability of landiolol for rapid AF/AFL and refractory ventricular tachyarrhythmias (VTs) in patients with heart failure.


METHODS
A total of 39 patients with AF/AFL with ventricular response ≥120 bpm and 12 VTs were retrospectively enrolled. Landiolol Responders for rapid AF/AFL were defined as patients whose ventricular response was suppressed to less than 110 bpm or decreased by ≥20% from the initial heart rate after administration of landiolol. Responders for VTs were defined as patients with no recurrent VTs during the 24 h after the initiation of landiolol.


RESULTS
For AF/AFL, 29 patients (74%) were Responders. In nine patients (31%), AF was spontaneously terminated after starting landiolol. Eight Non-Responders (80%) needed to have AF terminated by cardioversion. Left ventricular ejection fraction (LVEF) at baseline was significantly associated with landiolol efficacy. For VTs, seven patients (58%) were Responders, and smaller LV diastolic and systolic diameters were associated with landiolol efficacy. Hypotension after landiolol treatment occurred in 5 of 51 patients, and lower LV systolic function was associated with the development of adverse events.


CONCLUSIONS
Landiolol is effective in patients with heart failure not only due to rapid AF/AFL but also due to VTs. However, preserved LVEF is important for efficacy and safety in landiolol treatment.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
Yuko
Y
Wada
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Takeshi
T
Aiba
Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Otsu, Japan.
Yasuyuki
Y
Tsujita
Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
Hideki
H
Itoh
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Mitsuru
M
Wada
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Ikutaro
I
Nakajima
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Kohei
K
Ishibashi
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Hideo
H
Okamura
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Koji
K
Miyamoto
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Takashi
T
Noda
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Yasuo
Y
Sugano
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Hideaki
H
Kanzaki
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Toshihisa
T
Anzai
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Kengo
K
Kusano
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Satoshi
S
Yasuda
Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
Minoru
M
Horie
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Hisao
H
Ogawa
Arrhythmias; Heart failure; LV dysfunction; Landiolol; β-Blockers