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

Abstract

Introduction: Landiolol hydrochloride reduces the incidence of perioperative atrial fibrillation (AF) in cardiac surgery; however, little evidence is available regarding its effects in other types of surgery, including esophagectomy. We assessed the hypothesis that landiolol reduces perioperative AF and other complications associated with esophagectomy. Methods: This single-center, randomized, double-blind, parallel-group study enrolled patients scheduled for esophagectomy. Patients were divided into those given landiolol at 3 μg/kg/min or placebo for 24 h. The primary outcome was the proportion of patients who developed AF within 96 h starting at 9:00 AM on the day of surgery. The secondary outcomes were the proportion of patients whose AF appeared within 24 h, other complications based on the Clavien-Dindo classification, and the intensive care unit and hospital stays. Results: Despite early study termination, 80 patients were screened, and 56 were enrolled (28/group) from September 2016 to June 2018. AF occurred within 96 h of surgery in six (21.4%) patients in the landiolol group and five (17.9%) patients in the placebo group (odds ratio, 1.26; 95% confidence interval, 0.33-4.7) and within 24 h of surgery in three (10.7%) patients in the landiolol group and two (7.1%) patients in the placebo group. There were no significant differences in the incidence of complications or in the number of intensive care unit or hospital stays between the groups. Conclusion: Although our small sample size prevents definitive conclusions, landiolol might not reduce the occurrence of AF or other complications.

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

“…Evidence of prevention of AF with landiolol after NCS is less robust and inconsistent than in the context of cardiac surgery. [202][203][204][205] The timing of the initiation of beta-blockers to prevent AF remains unclear, with most prophylactic regimens using shortacting agents being started intra-operatively. 187…”

Landiolol for Treatment of New-Onset Atrial Fibrillation in Critical Care: A Systematic Review

“…The four retrospective studies, which included a historical group control principally using a calcium blocker or digoxin, tend to show a faster conversion and higher rate of conversion to SR for the landiolol group [14,16,24,29]. In contrast, many RCTs have assessed landiolol for postoperative AF prevention in ICU patients [12,[43][44][45][46]. Although recommendations for managing AF are mainly derived from acute cardiac care units or cardiac surgery, critically ill patients have specific risk factors that need consideration.…”

Beta-Blocker Landiolol Hydrochloride in Preventing Atrial Fibrillation Following Cardiothoracic Surgery: A Systematic Review and Meta-Analysis

“…In total, 13 RCTs and four cohorts studied were included in this meta-analysis. Ten articles studied the prognosis of landiolol hydrochloride infusion for the prevention of POAF in patients undergoing cardiac surgery, 15,[25][26][27][28][29][30][31][32][33] four articles focused on the esophageal surgery, [34][35][36][37] and three articles were studies on patients undergoing lung surgery. 20,38,39) A total of 1349 patients were included, and each study included 15-230 patients ranging in age from 62 to 83.…”