Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol

Abstract

BackgroundLandiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF) after cardiac surgery.MethodsOf the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3–5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group) and those who did not receive any β-blockers during surgery (control group). An unpaired t test and Fisher’s exact test were used to compare between-group differences in mean values and categorical data, respectively.ResultsSeventeen of the 105 patients (16.2%) developed postoperative atrial fibrillation: 5/57 (8.8%) in the landiolol group and 12/48 (25%) in the control group. There was a significant difference between the two groups (P=0.03). The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant.ConclusionsOur retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.

Continuous administration of landiolol reduced QT dispersion in postoperative patients

“…Recently, more and more results showing the efficacy of landiolol in terminating postoperative atrial fibrillation [8,17,18]. Beta blockers reduce the rate of sudden death, and research has pointed to a beneficial effect in patients with ventricular tachyarrhythmias [19].…”

Minimally invasive beating heart technique for redo mitral valve surgery in patients with giant left ventricle

“…We obtained satisfactory results through a left ventricular drainage tube that was inserted right pulmonary vein. Meanwhile, we adopted remifentanil [23]and landiolol [24]that were helpful for heart rate reduction to prevent regurgitant blood flow from coming up to the operative field for very slight aortic insufficiency.…”

Beating heart mitral valve repair for a patient with previous coronary bypass: a case report and review of the literature

“…Although we used 2 drop-in suckers through the left atrial incision in this particular case, a left ventricular vent via the apex using mini-left thoracotomy was useful in our previous experience. Remifentanil [8] and Landiolol [9] were helpful for heart rate reduction to prevent regurgitant blood flow from coming up to the operative field. Another concern is the possibility of air embolism.…”