Postoperative administration of landiolol hydrochloride for patients with supraventricular arrhythmia: the efficacy of sustained intravenous infusion at a low dose☆

Abstract

The purpose of this study was to investigate the efficacy of landiolol hydrochloride, a short-acting  1 blocker, by initiating its administration at a low dose (5 g  kg -1  min -1 ) in patients with postoperative supraventricular arrhythmia. The efficacy of landiolol was evaluated in 38 patients who, after developing postoperative atrial flutter or fibrillation, with sinus tachycardia and 2 patients who had a history of paroxysmal atrial fibrillation with frequent atrial extrasystole. The heart rate and blood pressure before and 2 hours after the administration of landiolol were compared. A return to the sinus rhythm from supraventricular arrhythmia was noted in 89%. The heart rate was reduced from 137  26 bpm (before landiolol administration) to 93  18 bpm (2 hours after the start of the medication, P < 0.01). As an agent to correct an arrhythmic condition, landiolol successfully raised the systolic blood pressure from 108  24 mmHg (before medication) to 120  19 mmHg (2 hours after the medication was started, P < 0.05). Continuous intravenous infusion of landiolol at a low dose was found to be effective for postoperative supraventricular arrhythmia.

Efficacy of low-dose landiolol, an ultrashort-acting β-blocker, on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer

“…The clinical effi cacy and safety of lowdose landiolol for postoperative tachycardia have been recognized. 12,20 Wariishi et al 20 reported, in a single-arm study, that low-dose landiolol (maximum dosage 7.5 ± 7.6 μg/kg/min) signifi cantly reduced the heart rate and elevated the systolic blood pressure in patients with postoperative supraventricular arrhythmia. In this study, low-dose landiolol (mean maximum dosage 6.6 ± 2.4 μg/ kg/min) demonstrated suffi cient effi cacy for the treatment of postoperative AF following pulmonary resection without side effects.…”

Landiolol for managing atrial fibrillation in post-cardiac surgery

“… 15 , 16 This was confirmed by another study using similar to slightly higher doses (7.5 ± 7.6 mcg/kg/min) which showed 89% of patients controlled with minimally impact on blood pressure. 19 …”

Effect of landiolol hydrochloride, an ultra-short-acting beta 1-selective blocker, on supraventricular tachycardia, atrial fibrillation and flutter after pulmonary resection

“…Landiolol shows outstanding cardioselectivity (β1/β2 = 255) with very little α‐blocking action and has an extremely short duration of action (half‐life of 4 min) 6 . Because of its high selectivity for β1‐receptors, landiolol can be administered to patients with respiratory disease 12 . Its dose adjustability allows landiolol to be effective for the treatment of post‐operative AF in patients undergoing cardiovascular surgery, 12,13 and administration of landiolol after cardiovascular surgery does not influence cardiac function parameters such as blood pressure or the cardiac index 12,13 .…”

“…The major pharmacological actions of b-blockers include suppression of abnormal myocardial responses to stimuli and reduction in the heart rate, but a direct defibrillating effect is rare. 12 The cardiovascular effects of landiolol have been compared with those of esmolol in a canine model, showing a similar or slightly more potent b-blocking action of landiolol with significantly less suppression of cardiovascular parameters. 14,15 However, differences of clinical efficacy for SVT between landiolol and other agents have not been fully clarified.…”

“…Because of its high selectivity for β1‐receptors, landiolol can be administered to patients with respiratory disease 12 . Its dose adjustability allows landiolol to be effective for the treatment of post‐operative AF in patients undergoing cardiovascular surgery, 12,13 and administration of landiolol after cardiovascular surgery does not influence cardiac function parameters such as blood pressure or the cardiac index 12,13 . In patients with AF after pulmonary resection, it has been suggested that cardiac function is better preserved than after cardiovascular surgery, which prompted us to perform the current study.…”