Randomized clinical trial of landiolol hydrochloride for the prevention of atrial fibrillation and postoperative complications after oesophagectomy for cancer

Ojima, Toshiyasu; Nakamori, Mikihito; Nakamura, Masaki; Katsuda, Masahiro; Hayata, Keiji; Kato, Tomoya; Kitadani, Junya; Tabata, Hiroki; Takeuchi, Akihiro; Yamaue, Hiroki

doi:10.1002/bjs.10548

Cited by 46 publications

(47 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ojima et al also administered landiolol at 3 μg/kg/ min from post-operative day (POD) 1 for 72h and, when compared to a placebo group of 100 patients, use of landiolol significantly reduced the incidence of POAF within the first postoperative week (incidence: landiolol: 30% vs placebo: 10%, p=0.012) and the overall incidence of postoperative complications (incidence: landiolol: 40% vs placebo: 60%, p=0.046). 22 Horikoshi et al administered landiolol at 5 μg/kg/ min from the induction of anesthesia until the morning of POD 1 and use of landiolol significantly reduced the incidence of POAF (incidence: landiolol: 5.3% vs placebo: 35%, p<0.05) and also sinus tachycardia (incidence: landiolol: 0% vs placebo: 25%, p<0.05). 23 Moreover, they evaluated postoperative inflammation cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α) and use of landiolol significantly suppressed IL-6 elevation but not other cytokines.…”

Section: Role Of Prophylactic Landiolol In Non-cardiac Surgeriesmentioning

confidence: 99%

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

Matsuishi¹,

Mathis²,

Shimojo³

et al. 2020

VHRM

View full text Add to dashboard Cite

Background: Landiolol hydrochloride, a highly cardio-selective beta-1 blocker with an ultra-short-acting half-life of 4 minutes, was originally approved by Japan for treatment of intraoperative tachyarrhythmias. This review aims to provide an integrated overview of the current state of knowledge of landiolol hydrochloride in the management of arrhythmia in critical settings. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library to retrieve relevant articles with a total of 65 records identified. Results: The high β1 selectivity (β1/β2 ratio of 255:1) of landiolol causes a more rapid heart rate (HR) decrease compared to esmolol while avoiding decreases in mean arterial blood pressure. Recently, it has been found useful in left ventricular dysfunction patients and fatal arrhythmia requiring emergency treatment. Recent random clinical trials (RCT) have revealed therapeutic and prophylactic effects on arrhythmia, and very low-dose landiolol might be effective for preventing postoperative atrial fibrillation (POAF) and sinus tachycardia. Likewise, landiolol is an optimal choice for perioperative tachycardia treatment during cardiac surgery. The high β1 selectivity of landiolol is useful in heart failure patients as a first-line therapy for tachycardia and arrhythmia as it avoids the typical depression of cardiac function seen in other β-blockers. Application in cardiac injury after percutaneous coronary intervention (PCI), protection for vital organs (lung, kidney, etc.) during sepsis, and stabilizing hemodynamics in pediatric patients are becoming the new frontier of landiolol use. Conclusion: Landiolol is useful as a first-line therapy for the prevention of POAF after cardiac/non-cardiac surgery, fatal arrhythmias in heart failure patients and during PCI. Moreover, the potential therapeutic effect of landiolol for sepsis in pediatric patients is currently being explored. As positive RCT results continue to be published, new clinical uses and further clinical studies in various settings by cardiologists, intensivists and pediatric cardiologists are being conducted.

show abstract

Section: Role Of Prophylactic Landiolol In Non-cardiac Surgeriesmentioning

confidence: 99%

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

Matsuishi¹,

Mathis²,

Shimojo³

et al. 2020

VHRM

View full text Add to dashboard Cite

show abstract

“…To explore the possibility that studies with nonsignificant results (no effect of AF) were not being published, a funnel plot analysis was done. No publication bias was detected in terms of postoperative (within 30 days) Mc Cormack et al 60 Chin et al 58 Wee et al 63 Mao et al 46 Guven et al 62 Ojima et al 15 Seesing et al 28 Pan et al 44 Ojima et al 13 Fei Yao et al 49 Shridhar et al 45 Rao et al 55 Merritt et al 31 Hua et al 52 Stawicki et al 30 Feng et al 51 Kernstine et al 34 Seely et al 47 Ma et al 32 Overall ( Mc Cormack et al 60 Wee et al 63 Mao et al 46 Guven et al 62 Ojima et al 15 Seesing et al 28 Pan et al 44 Wang et al 64 Yao et al 49 Shridhar et al 45 Yoshida et al 12 Hou et al 33 Collins et al 35 Feng et al 51 Kernstine et al 34 Murthy et al 36 Ma et al 32 Overall (I 2 = 34·7%, P = 0·079)…”

Section: Odds Ratio Odds Ratio Weight (%)mentioning

confidence: 99%

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Schizas

Kosmopoulos

Giannopoulos

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background: Oesophagectomy is associated with high morbidity and mortality rates. New-onset atrial fibrillation (AF) is a frequent complication following oesophagectomy. Several studies have explored whether new-onset AF is associated with adverse events after oesophagectomy.Methods: This review was performed according to PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 25 November 2018. A meta-analysis was conducted with the use of random-effects modelling. The I 2 statistic was used to assess for heterogeneity.Results: In total, 53 studies including 9087 patients were eligible for analysis. The overall incidence of postoperative AF was 16⋅5 per cent. Coronary artery disease and hypertension were associated with AF, whereas diabetes, smoking and chronic obstructive pulmonary disease were not. Patients with AF had a significantly higher risk of overall postoperative adverse events than those without fibrillation (odds ratio (OR) 5⋅50, 95 per cent c.i. 3⋅51 to 8⋅30), including 30-day mortality (OR 2⋅49, 1⋅70 to 3⋅64), anastomotic leak (OR 2⋅65, 1⋅53 to 4⋅59) and pneumonia (OR 3⋅42, 2⋅39 to 4⋅90).Conclusion: Postoperative AF is frequently observed in patients undergoing oesophagectomy for cancer. It is associated with an increased risk of death and postoperative complications.

show abstract

“…Landiolol was well tolerated with minimal haemodynamic impact. In the larger randomized controlled trial (RCT) by Ojima et al ., 32 landiolol reduced heart rate and induced a drop of blood pressure on the 1st post-operative day (POD1) which normalized on POD2. One study reported a low incidence of hypotension (3%) which resolved quickly upon reducing dose.…”

Section: Landiolol Use To Prevent Post-operative Atrial Fibrillationmentioning

confidence: 99%

Landiolol for managing post-operative atrial fibrillation

Borggrefe

Sander

Trimmel

et al. 2018

European Heart Journal Supplements

View full text Add to dashboard Cite

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.

show abstract

Randomized clinical trial of landiolol hydrochloride for the prevention of atrial fibrillation and postoperative complications after oesophagectomy for cancer

Abstract: Landiolol was effective and safe in preventing atrial fibrillation after oesophagectomy. Registration number: UMIN000010648 (http://www.umin.ac.jp/ctr/).

Cited by 46 publications

References 32 publications

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

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

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Landiolol for managing post-operative atrial fibrillation

Contact Info

Product

Resources

About