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. 2022 Jun 13;24(Suppl D):D11-D21.
doi: 10.1093/eurheartjsupp/suac023. eCollection 2022 Jun.

Benefits and safety of landiolol for rapid rate control in patients with atrial tachyarrhythmias and acute decompensated heart failure

Tsuyoshi Shiga  1
Affiliations

Benefits and safety of landiolol for rapid rate control in patients with atrial tachyarrhythmias and acute decompensated heart failure

Tsuyoshi Shiga. Eur Heart J Suppl. .

Abstract

Atrial tachyarrhythmias often occur in patients with worsening heart failure (HF), and the development of atrial tachyarrhythmias in acute decompensated HF (ADHF) causes an uncontrolled heart rate (HR) and leads to further exacerbation of HF and persistence of a decompensated HF state. Landiolol, a short-acting intravenous beta-1 blocker, shows very high cardiac beta-1 selectivity and has a very short elimination half-life of approximately 4 min. As shown in several reports, the benefit of intravenous landiolol is that it lowers the ventricular rate early after the start of use without markedly deteriorating haemodynamics. After the cardiac status is stabilized by rapid control of HR, subsequent basic HF pharmacotherapy and rhythm control therapies will be effective for improving outcomes. Because of the pharmacokinetic properties of landiolol, if the patient suffers an adverse reaction such as hypotension or bradycardia, such effects can be quickly reversed by tapering the dose or discontinuing use altogether. Based on several clinical studies, this review discusses the efficacy, safety and role of intravenous landiolol in acute HR control in patients with atrial tachyarrhythmias and ADHF.

Keywords: Atrial fibrillation; Beta blockers; Heart failure; Landiolol; Rate control.

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Figures

Figure 1
Figure 1
Sinus rhythm restoration in patients with atrial tachyarrhythmias and acute decompensated heart failure during and after intravenous landiolol infusion. Reproduced from Matsui et al. The median maintenance dosage of intravenous landiolol was 3.0 (range 1.0–12.0) μg/kg/min, and the median treatment duration of intravenous landiolol was 5 days. ECV, electrical cardioversion; PCV, pharmacological cardioversion.
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