Experimental evidence for a severe proarrhythmic potential of levosimendan

Frommeyer, Gerrit; Kohnke, Anja; Ellermann, Christian; Dechering, Dirk G.; Kochhäuser, Simon; Pott, Christian; Fehr, Michael; Eckardt, Lars

doi:10.1016/j.ijcard.2016.11.251

Cited by 10 publications

(3 citation statements)

References 18 publications

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“…However, in this study, calcium ion sensitizers (OR =3.14, 95% CI: 1.10–9.21, P=0.033) were independent risk factors, and, therefore, they should be applied cautiously after surgery. A previous study also confirmed that levosimendan may increase the risk of postoperative arrhythmia ( 38 ). There is evidence that calcium overload due to reperfusion of ischemic areas is one of the potential arrhythmogenic mechanisms of arrhythmia after cardiac surgery ( 39 ).…”

Section: Discussionsupporting

confidence: 59%

Development and validation of a diagnostic model based on left atrial diameter to predict postoperative atrial fibrillation after off-pump coronary artery bypass grafting

Zhang¹,

Qiao²,

Yang³

et al. 2023

J Thorac Dis

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Background This cohort study collected the clinical data of patients who underwent off-pump coronary artery bypass grafting (OPCABG) during hospitalization to observe the occurrence of postoperative atrial fibrillation (POAF), construct a POAF prediction model for CABG patients based on the left atrial diameter (LAD), and assist clinicians in making better medical decisions. Methods In this study, all patients who had no prior history of arrhythmia and who had received isolated OPCABG between May 1, 2021, and February 1, 2022, at Beijing Anzhen Hospital Affiliated to Capital Medical University (n=749) were reviewed. Depending on an optimal cutoff obtained from receiver operating characteristic (ROC) curve analysis, patients were separated into two groups: a group with POAF (n=188) and a group without POAF (n=561). The incidence of POAF was then compared. Prediction models were built, and nomograms were plotted was plotted. Model evaluation, including calibration curve and decision curve analysis, was performed. Results In all, 188 out of 749 (25.1%) patients who underwent cardiac surgery experienced POAF. Multifactorial logistic regression analysis showed that age ≥66 years, LAD ≥39 mm, and post-OPCABG atrial fibrillation (AF) were independently associated. The prognostic nomogram model showed good concordance index (C-index) scores. Decision curve analysis suggested the clinical benefit of the prediction models. Conclusions In this study, a prediction model for patients with POAF after OPCABG was assessed, which was shown to make more accurate predictions compared with the original risk prediction system. It may assist doctors to optimize management of patients with POAF.

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Section: Discussionsupporting

confidence: 59%

Development and validation of a diagnostic model based on left atrial diameter to predict postoperative atrial fibrillation after off-pump coronary artery bypass grafting

Zhang¹,

Qiao²,

Yang³

et al. 2023

J Thorac Dis

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“…Moreover, the magnitude of such increases is critically dose-dependent, and these increases are small at therapeutically relevant doses and plasma drug levels [ 9 ]. Furthermore, in vitro study has shown that acute infusion of levosimendan may lead to an increased occurrence of ventricular tachyarrhythmias in an experimental whole-heart model and the underlying mechanism for the increased inducibility of ventricular fibrillation in the present study is a significant abbreviation of ventricular repolarization and a reduction of ventricular refractory period [ 21 ].…”

Section: Discussionmentioning

confidence: 92%

Case report: A 56-year-old woman presenting with torsades de pointes and cardiac arrest associated with levosimendan administration and underlying congenital long QT syndrome type 1

Zha,

Li,

Yin

et al. 2024

Heliyon

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“…9,10) One experimental study also showed a severe proarrhythmic effect of levosimendan, its administration increasing the inducibility of life-threatening arrhythmias in a dosedependent manner. 11) Levosimendan also tends to prolong the rate-corrected QT interval in healthy volunteers, although such an effect has not always been observed in patients with heart failure treated with therapeutic doses. 12) Therefore, some authors have suggested a combination of levosimendan and β-blockers, particularly in patients with a tendency to tachyarrhythmia.…”

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confidence: 99%

Successful Combination of Landiolol and Levosimendan in Patients with Decompensated Heart Failure

Dąbrowski¹,

Siwicka-Gieroba²,

Piasek³

et al. 2020

Int. Heart J.

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Tachycardia and supraventricular tachyarrhythmias often impair cardiovascular capacity in patients with decompensated heart failure (dHF) treated with inotropes. Normalization of heart rhythm or rate typically improves diastolic filling and stroke volume (SV). Thus, isochronal administration of an ultra-short-acting and highly selective β1-blockers, such as landiolol, along with inotropic calcium-sensitizer medications, such as levosimendan, could benefit patients with dHF.We present a case series of three patients with severe dHF and low ejection fraction who were successfully treated with a combination of landiolol and levosimendan. The co-administration of landiolol and levosimendan was well tolerated, improved cardiac function, normalized SV, and enabled the reduction of norepinephrine dosing in all patients. Additionally, the combination improved the vectorcardiographic spatial QRS-T angle and decreased the corrected QT interval. All patients were successfully discharged from the intensive care unit (ICU).A combination of levosimendan and landiolol was safe and well-tolerated. This combination may be a new option for successful treatment of patients with acute dHF complicated by sinus or supraventricular tachycardias.(Int Heart J 2020; 61: 384-389)

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Experimental evidence for a severe proarrhythmic potential of levosimendan

Cited by 10 publications

References 18 publications

Development and validation of a diagnostic model based on left atrial diameter to predict postoperative atrial fibrillation after off-pump coronary artery bypass grafting

Development and validation of a diagnostic model based on left atrial diameter to predict postoperative atrial fibrillation after off-pump coronary artery bypass grafting

Case report: A 56-year-old woman presenting with torsades de pointes and cardiac arrest associated with levosimendan administration and underlying congenital long QT syndrome type 1

Successful Combination of Landiolol and Levosimendan in Patients with Decompensated Heart Failure

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