Landiolol for managing post-operative atrial fibrillation

Abstract

Beta-blockers are a potential option to manage peri-operative atrial fibrillation. Landiolol is a new ultra-short beta-blocker with a half-life of only 4 minutes and very high beta-1 selectivity which has been used for treatment and prevention of atrial fibrillation in pulmonary surgery and gastro-intestinal surgery. Due to its limited negative inotropic effect and high beta-1 selectivity landiolol allows for control of heart rate with minimal impact on blood pressure. Landiolol is well tolerated by the respiratory system. Additional benefits are related to the regulation of the inflammatory response and blunting of the adrenergic pathway. There is a limited number of trials with total of 61 patients undergoing lung resection or oesophagectomy who developed post-operative atrial fibrillation and were treated with landiolol. The experience with landiolol for prevention is more documented than landiolol application for treatment of post-operative atrial fibrillation. There are 9 comparative studies with a total of 450 patients administered landiolol for prevention of post-operative atrial fibrillation. The use of low dosage (5-10mcg/kg/min) is usually sufficient to rapidly control heart rate which is associated with earlier and higher rate of conversion to sinus rhythm as compared to the controls. The excellent tolerance of landiolol at lower dosage (3-5mcg/kg/min) allows to initiate prophylactic use during surgery and postoperatively. Landiolol prophylaxis is associated with reduced incidence of post-operative atrial fibrillation without triggering adverse events related to a beta-blockade.

Landiolol for managing atrial fibrillation in post-cardiac surgery

“…These results are consistent with the observations provided by the two retrospective studies 16 , 17 and in line with results from controlled studies in non-cardiac surgery (see article by Balik et al . 18 from this supplement). Landiolol tolerance was better than diltiazem, displaying less hypotension, and less bradycardia.…”

<p>Evaluating the Therapeutic Efficacy and Safety of Landiolol Hydrochloride for Management of Arrhythmia in Critical Settings: Review of the Literature</p>

“…There are several observational studies that have used landiolol to manage perioperative arrhythmia and reported prophylactic effects against POAF, [24][25][26][27][28][29][30] treatment of POAF, 31 treatment of supraventricular tachycardia (SVT), 32 different treatment effects between AF and AFL/atrial tachycardia (AT), 33 safe decreases in HR and improvement of hemodynamics in patients receiving catecholamine. 34 RCTs have already been conducted to study the effect of landiolol on prevention of POAF after cardiac surgery ( Table 2).…”

Landiolol hydrochloride for prevention of atrial fibrillation during esophagectomy: a randomized controlled trial

“…4 Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan. 5 Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan. 6 Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan.…”

“…Landiolol hydrochloride is an ultrashort-acting β1selective blocker with a short half-life and does not trigger adverse events [5]. Several studies have shown that low-dose (0.5-10.0 μg/kg/min) landiolol administration prevents perioperative AF following cardiac surgery [6][7][8][9][10].…”

“…This finding must be interpreted with caution, however, because of limitations in the study protocol. Although the AF-preventive effect of landiolol has been studied extensively in cardiac surgery, there is little evidence regarding the effectiveness of its use in other types of surgery, including esophagectomy [5].…”