Urgent Management of Rapid Heart Rate in Patients With Atrial Fibrillation/Flutter and Left Ventricular Dysfunction

A Low-Dose β₁-Blocker Effectively and Safely Slows the Heart Rate in Patients with Acute Decompensated Heart Failure and Rapid Atrial Fibrillation

“…Very recently, Nagai et al [31], in a prospective, multicenter, single-blind, randomized, parallel-group study, found that landiolol can safely lower the ventricular rate in patients with rapid AF and LV dysfunction, and that this rate control effect of landiolol is superior to that of digoxin within 2 h. This result (the J-Land study) was very similar to the data obtained in the present study. However, when their data and ours are compared in more detail, we find several points of difference: (1) the ratio between NYHA classes III and IV was 81.9/18.1% [31] versus 10/90% (our data); (2) the mean doses of landiolol at 2 h were 6.7 ± 3.2 versus 1.5 ± 0.5 µg·kg -1 ·min -1 , respectively; (3) the rates of heart failure with reduced EF were 100 versus 52%, and (4) the rates of atrial flutter were 10 versus 0%, respectively.…”

“…The difference in maximal landiolol dosage may be dependent on the protocol (their primary endpoint was the percentage of patients with both an HR <110 beats·min -1 and a decrease of 20% or more from baseline at 2 h after landiolol treatment) and different baseline patient characteristics; that is, the present study included patients with SHF or DHF due to different etiologies and pathophysiological mechanisms (AMI, DCM, ICM vs. HCM, HHD). Interestingly, the rate of HR reduction in the SHF group (n = 12) and in the landiolol group of Nagai et al [31] (n = 87) 2 h after the administration of landiolol were 15 and 20%, respectively (fig. 3).…”

“…However, when their data and ours are compared in more detail, we find several points of difference: (1) the ratio between NYHA classes III and IV was 81.9/18.1% [31] versus 10/90% (our data); (2) the mean doses of landiolol at 2 h were 6.7 ± 3.2 versus 1.5 ± 0.5 µg·kg -1 ·min -1 , respectively; (3) the rates of heart failure with reduced EF were 100 versus 52%, and (4) the rates of atrial flutter were 10 versus 0%, respectively. The difference in maximal landiolol dosage may be dependent on the protocol (their primary endpoint was the percentage of patients with both an HR <110 beats·min -1 and a decrease of 20% or more from baseline at 2 h after landiolol treatment) and different baseline patient characteristics; that is, the present study included patients with SHF or DHF due to different etiologies and pathophysiological mechanisms (AMI, DCM, ICM vs. HCM, HHD).…”

The Role of β-Blockers in Cardiac Perioperative Management

“…As a result of this study, the rate of achieving the primary endpoint (hear rate <110/min after 2 h of administration and a decrease of the heart rate by ≥20%) was significantly higher in the landiolol group (48%) than in the digoxin group (13.9%), along with fewer adverse reactions such as hypotension. 25) Since the efficacy and safety of landiolol were demonstrated by this study, it is expected that it will also be approved for treating tachyarrythmias in patients with cardiac dysfunction. A number of large-scale studies have shown that oral β-blockers can improve the prognosis of patients with cardiac failure and acute myocardial infarction, but there is insufficient evidence reagrding injectable β-blockers.…”

Newly developed atrial fibrillation progresses to a more severe INTERMACS score in a patient with advanced heart failure due to dilated cardiomyopathy

“…One study proposed the use of landiolol to safely reduce the heart rate without suppressing cardiac function in patients with a reduced ejection fraction as well as in patients with severe LV dysfunction 28. Another study suggested that landiolol was more effective for urgent heart rate control than digoxin and did not increase the incidence of adverse events 29. These rate control therapeutics may have comparatively smaller effects than rhythm control therapies.…”