Hemodynamic and Rhythmologic Effects of Push-Dose Landiolol in Critical Care—A Retrospective Cross-Sectional Study

Abstract

Background: The highly β1-selective beta-blocker Landiolol is known to facilitate efficient and safe rate control in non-compensatory tachycardia or dysrhythmia when administered continuously. However, efficacy and safety data of the also-available bolus formulation in critically ill patients are scarce. Methods: We conducted a retrospective cross-sectional study on a real-life cohort of critical care patients, who had been treated with push-dose Landiolol due to sudden-onset non-compensatory supraventricular tachycardia. Continuous hemodynamic data had been acquired via invasive blood pressure monitoring. Results: Thirty patients and 49 bolus applications were analyzed. Successful heart rate control was accomplished in 20 (41%) cases, rhythm control was achieved in 13 (27%) episodes, and 16 (33%) applications showed no effect. Overall, the heart rate was significantly lower (145 (130–150) vs. 105 (100–125) bpm, p < 0.001) in a 90 min post-application observational period in all subgroups. The median changes in blood pressure after the bolus application did not reach clinical significance. Compared with the ventilation settings before the bolus application, the respiratory settings including the required FiO2 after the bolus application did not differ significantly. No serious adverse events were seen. Conclusions: Push-dose Landiolol was safe and effective in critically ill ICU patients. No clinically relevant impact on blood pressure was noted.

The Impact of Chronic Oral Beta-Blocker Intake on Intravenous Bolus Landiolol Response in Hospitalized Intensive Care Patients with Sudden-Onset Supraventricular Tachycardia—A Post Hoc Analysis of a Cross-Sectional Trial

“…In this study, we were able to show that prior administration of oral β-blockers had no significant impact on rate or rhythm control after Landiolol bolus administration ( Figure 2 sums up the study findings). As already described in our initial cross-sectional study [ 17 ], Landiolol appears to have a high potential for successful rate and rhythm control in critically ill patients with a sudden onset of tachyarrhythmia (rate control in 11 and rhythm control in 9 patients). However, in one-third of patients, there was no effect.…”

“…In this study, we were able to show that prior administration of oral β-blockers had no significant impact on rate or rhythm control after Landiolol bolus administration (Figure 2 sums up the study findings). As already described in our initial cross-sectional study [17],…”

“…This study is a retrospective analysis of a cross-sectional study [ 17 ] that analyzed patients who received a bolus application of Landiolol for the treatment of sudden-onset tachycardic arrhythmia during their stay in an intensive care unit. The administration of Landiolol was based on the clinical decision of the attending physician.…”

An Overview of the Pharmacokinetics and Pharmacodynamics of Landiolol (an Ultra-Short Acting β1 Selective Antagonist) in Atrial Fibrillation

“…However, compelling evidence suggests that inflammation and oxidative stress play significant roles in the development of AF [ 78 ]. Landiolol showed a protective effect on LPS-induced systemic inflammation model in an animal study, being associated with a decrease in high mobility group box-1 protein (HMGB-1) and decreasing IL-6 levels, while inhibiting TNF-alpha levels [ 78 , 79 ]. The animal model demonstrated that landiolol’s anti-inflammatory effect extends to the inhibition of the inflammatory and vasoconstrictor peptide endothelin (ET) 1 [ 80 ].…”