Benefits and safety of landiolol for rapid rate control in patients with atrial tachyarrhythmias and acute decompensated heart failure

Abstract

Atrial tachyarrhythmias often occur in patients with worsening heart failure (HF), and the development of atrial tachyarrhythmias in acute decompensated HF (ADHF) causes an uncontrolled heart rate (HR) and leads to further exacerbation of HF and persistence of a decompensated HF state. Landiolol, a short-acting intravenous beta-1 blocker, shows very high cardiac beta-1 selectivity and has a very short elimination half-life of approximately 4 min. As shown in several reports, the benefit of intravenous landiolol is that it lowers the ventricular rate early after the start of use without markedly deteriorating haemodynamics. After the cardiac status is stabilized by rapid control of HR, subsequent basic HF pharmacotherapy and rhythm control therapies will be effective for improving outcomes. Because of the pharmacokinetic properties of landiolol, if the patient suffers an adverse reaction such as hypotension or bradycardia, such effects can be quickly reversed by tapering the dose or discontinuing use altogether. Based on several clinical studies, this review discusses the efficacy, safety and role of intravenous landiolol in acute HR control in patients with atrial tachyarrhythmias and ADHF.

Avaliação da segurança terapêutica dos betabloqueadores na insuficiência cardíaca aguda na emergência hospitalar

“…Em revisão sistemática realizada em 2022, o autor observou que as dosagens de landiolol, mais comumente manejado e utilizado em centros hospitalares do Japão, variam de 1,0 a 10,0 μg/kg/min em infusão contínua, mas que em parte dos estudos analisados o efeito de redução da FC nem sempre é suficiente, visto que em grande parte dos pacientes com IC aguda apresentam distúrbio no sistema neuro-modualdor simpático, o que diminui a eficácia desse fármaco em tais pacientes. Um dos autores analisados sugeriu o uso de dosagens elevadas, de até 20,0 μg/kg/min, para a conseguir a FC esperada, mas três pacientes desenvolveram hipotensão transitória e o landiolol foi descontinuado sem mais complicações adversas decorrentes (Shiga, 2022).…”

Management of atrial flutter and atrial fibrillation with rapid ventricular response in patients with acute decompensated heart failure: A systematic review

“…The 2020 ESC guidelines do not specifically comment on the use of BBs in this patient population 24 . Notably, however, landiolol, an ultra‐short‐acting beta‐1 receptor selective antagonist, has shown promise for the management of AFRVR in ADHF in single‐arm studies 28 . Nevertheless, there is a general lack of data preventing definitive conclusions regarding the safety and efficacy of BB therapy for the acute management of AFRVR and ADHF.…”

Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation

“…Therefore, when managing acute AF, a comprehensive evaluation and active management of potential triggers should be simultaneously performed. [345] 7.1 Emergency Ventricular Rate Control Before initiating rate control in AF, potential causes of increased ventricular rate should be evaluated, such as myocardial ischemia, infection, anemia, and pulmonary embolism, and it should be determined whether the increased ventricular rate is a compensatory mechanism. In patients with acute onset of AF, symptoms usually improve rapidly after urgent rate control.…”