Perioperative Landiolol Administration reduces Atrial Fibrillation after Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Abstract

IntroductionPostoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery. Patients who develop POAF have a prolonged stay in the intensive care unit and hospital and an increased risk of postoperative stroke. Many guidelines for the management of cardiac surgery patients, therefore, recommend perioperative administration of beta-blockers to prevent and treat POAF. Landiolol is an ultra-short acting beta-blocker, and some randomized controlled trials of landiolol administration for the prevention of POAF have been conducted in Japan. This meta-analysis evaluated the effectiveness of landiolol administration for the prevention of POAF after cardiac surgery.MethodsThe Medline/PubMed and BioMed Central databases were searched for randomized controlled trials comparing cardiac surgery patients who received perioperative landiolol with a control group (saline administration, no drug administration, or other treatment). Two independent reviewers selected the studies for inclusion. Data regarding POAF and safety outcomes were extracted. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel method (fixed effects model).ResultsSix trials with a total of 560 patients were included in the meta-analysis. Landiolol administration significantly reduced the incidence of POAF after cardiac surgery (OR 0.26, 95% CI 0.17–0.40). The effectiveness of landiolol administration was similar in three groups: all patients who underwent coronary artery bypass grafting (CABG) (OR 0.27, 95% CI 0.17–0.43), patients who underwent CABG compared with a control group who received saline or nothing (OR 0.28, 95% CI 0.17–0.45), and all patients who underwent cardiac surgery compared with a control group who received saline or nothing (OR 0.27, 95% CI 0.17–0.42). Only two adverse events associated with landiolol administration were observed (2/302, 0.7%): hypotension in one patient and asthma in one patient.ConclusionLandiolol administration reduces the incidence of POAF after cardiac surgery and is well tolerated.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0116-x) contains supplementary material, which is available to authorized users.

Clinical utility of landiolol for use in coronary CT angiography

“…29 In patients who undergo cardiac surgery, β-blockers are administered perioperatively without contraindications to reduce the incidence of postoperative atrial fibrillation. 9,30 Landiolol has been shown to inhibit postoperative atrial fibrillation after coronary artery bypass surgery, 9,14,15,[31][32][33] acute type A aortic dissection repair, 34 and heart valve surgery. 9,35 One study showed that landiolol was more effective than diltiazem for patients with postoperative atrial fibrillation after open heart surgery.…”

“…Hence, urgent heart rate reduction is necessary. However, the long half-life of intravenous metoprolol or propranolol (approximately 2-3 hours) is a shortcoming of these agents [7][8][9][10][11] because patients need to be observed for some time after coronary CT examination is performed. In addition, metoprolol has a low β1-selectivity and propranolol displays no significant β-adrenergic selectivity.…”

“…10,13 Landiolol was developed in Japan and approved for clinical use in 2002, 9,14,15 which further increased its cardioselectivity and shortened its half-life by replacing the side chain. The cardioselectivity of landiolol is much higher than that of esmolol (β1/β2 =255 vs 33) and its half-life is shorter (4 minutes vs 9 minutes).…”

“…The cardioselectivity of landiolol is much higher than that of esmolol (β1/β2 =255 vs 33) and its half-life is shorter (4 minutes vs 9 minutes). 9,10,13,16,17 Landiolol (Corebeta; Ono Pharmaceutical, Osaka, Japan) has been approved as a premedication for coronary CT angiography in Japan since 2011. 18 Landiolol would be an ideal intravenous β-blocker to achieve an optimal image quality in coronary CT angiography.…”

An Experience of Landiolol Use for an Advanced Heart Failure Patient With Severe Hypotension

“…Recently, many papers have reported on the benefits of landiolol for the control of perioperative tachyarrhythmias. 4) However, the indication of landiolol has been limited in patients with preserved ejection fraction, and only digoxin is indicated to control heart rate in patients with severe left ventricular (LV) dysfunction.…”