Myocardial protection: The efficacy of an ultra-short-acting β-blocker, esmolol, as a cardioplegic agent

Abstract

Intermittent arrest with esmolol did not enhance protection of intermittent crossclamping with fibrillation; however, multiple esmolol infusions during global ischemia provided improved protection. Administration (constant flow or constant pressure) of arresting solutions influenced outcome only during continuous infusion. Multidose esmolol arrest may be a beneficial alternative to intermittent crossclamping with fibrillation or conventional cardioplegia.

Landiolol has a less potent negative inotropic effect than esmolol in isolated rabbit hearts

“…The results of the present study also confi rm the reported features of esmolol; i.e., esmolol inhibits MVO 2 dose-dependently and has myocardial protective effects. Furthermore, myocardial contraction in the presence of esmolol at 1 · 10 −4 M was almost zero in the present study, whereas at higher concentrations (approximately 1.0 mM), esmolol was reported to induce cardiac arrest [21].…”

Effect of low-dose landiolol, an ultrashort-acting β-blocker, on postoperative atrial fibrillation after CABG surgery

“…36 Moreover, some studies using esmolol, another ultrashort-acting β-blocker, reported that β-blockers have a cardioprotective effect during reperfusion through various mechanisms. 37,38 Although landiolol is classifi ed an ultrashort-acting β-blocker, it exerts approximately nine times more potent β-blocking activity in vivo than esmolol and is eight times more cardioselective in vitro. 39 Moreover, the suppressive effects on cardiovascular performance are signifi cantly less potent for landiolol than those of esmolol at equipotent β-blocking doses.…”

The negative inotropic effect of esmolol on isolated cardiac muscle

“…However, it was pointed out that the hypotension could be avoided by careful titration, since esmolol has such a short duration of action. Esmolol has even been used for cardioplegia with an optimal arresting dose of 1.0 mmol/L (19). This is understandable if it is appreciated that esmolol, apart from being a clinically valuable beta blocking agent, also exhibits a blocking effect on the calcium current.…”