Preventive effect of low-dose landiolol on postoperative atrial fibrillation study (PELTA study)

Abstract

Objective To investigate the efficacy of prophylactic administration of low-dose landiolol on postoperative atrial fibrillation (POAF) in patients after cardiovascular surgery. Methods Consecutive 150 patients over 70 years of age who underwent cardiovascular surgery for valvular, ischemic heart, and aortic diseases were enrolled in this single-center prospective randomized control study from 2010 to 2014. They were assigned to three treatment groups: 1γ group (landiolol at 1 μg/kg/min), 2γ group (landiolol at 2 μg/kg/min), or control group (no landiolol). In the two landiolol groups, landiolol hydrochloride was intravenously administered for a period of 4 days postoperatively. Electrocardiography was continuously monitored during the study period, and cardiologists eventually assessed whether POAF occurred or not. Results POAF occurred in 24.4% of patients in the control group, 18.2% in 1γ group, and 11.1% in 2γ group (p = 0.256). Multivariate logistic regression analysis showed that the incidence of POAF tended to decrease depending on the dose of landiolol (trend-p = 0.120; 1γ group: OR = 0.786, 95% CI 0.257–2.404; 2γ group: OR = 0.379, 95% CI 0.112–1.287). Subgroup analysis showed a significant dose-dependent reduction in POAF among categories of female sex, non-use of angiotensin II receptor blockers (ARBs) before surgery, and valve surgery (each trend-p = 0.02, 0.03, and 0.004). Conclusions These findings indicate that prophylactic administration of low-dose landiolol may not be effective for preventing the occurrence of POAF in overall patients after cardiovascular surgery, but the administration could be beneficial to female patients, patients not using ARBs preoperatively, and those after valvular surgery.

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

“…Lanidiolol hydrochloride is a low-dose β-selective blocker that has been shown to give a negative ionotropic effect without the adverse outcomes of β-blockers at a low dose. While debated in literature, The PELTA (Preventive effect of low-dose Lanidiolol on postoperative atrial fibrillation) study showed landiolol has a preventative effect against POAF at low doses in patients who undergo CABG, valvular and aortic surgery [ 40 ].…”

Atrial Fibrillation after Lung Cancer Surgery: Prediction, Prevention and Anticoagulation Management

“…Studies aimed at determining the capacity of this drug to prevent POAF have involved both patients undergoing cardiac surgery and patients undergoing thoracic surgery; results confirmed landiolol's effectiveness in reducing POAF in the heart surgery setting. However, one study failed to prove any benefit in patients undergoing thoracic surgery [56][57][58]. A recent meta-analysis by Walter et al comparing landiolol to the standard of care (i.e., pooled control group treated with other beta-blockers or diltiazem or no prevention), showed the greater efficacy of the former, which also contributed to a significant reduction in hospital stay costs [59].…”

Meta-analysis of the benefit of beta-blockers for the reduction of isolated atrial fibrillation incidence after cardiac surgery

“…The final 21 papers were reviewed in full text, and the following were excluded due to the following reasons: 1 study did not have a control group, 6 1 study used sotalol as its study drug, 7 1 study did not segregate outcomes between isolated AF and other forms of SVT, 8 and 1 study focused on the combination therapy of b-blocker and magnesium. 9 Eventually, 17 RCTs, 5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] fully satisfying our predefined inclusion criteria, were selected from papers published in varying years. Figure 1 The included studies were published between 1983 and 2020 and are from 9 different countries (United States, United Kingdom, Germany, Turkey, Austria, Japan, China, Brazil, Australia) ( Table 1).…”

“…A greater number of studies involved intraoperative (n ¼ 9), 10,13,17,18,20,[22][23][24][25] followed by preoperative (n ¼ 4) [14][15][16]21 and postoperative initiation (n ¼ 4). 5,11,12,19 Starting dose of b-blocker was similarly varied. Among studies with IV administration, dosage ranged from <2 mg/kg/min (n ¼ 1), 5 2 mg/kg/min (n ¼ 4), 5,17,18,24 >2 mg/kg/min (n ¼ 5), 13,19,20,22,25 1 mg (n ¼ 1), 10 and <50 mg/d (n ¼ 1).…”

“…5,11,12,19 Starting dose of b-blocker was similarly varied. Among studies with IV administration, dosage ranged from <2 mg/kg/min (n ¼ 1), 5 2 mg/kg/min (n ¼ 4), 5,17,18,24 >2 mg/kg/min (n ¼ 5), 13,19,20,22,25 1 mg (n ¼ 1), 10 and <50 mg/d (n ¼ 1). 23 In contrast, with regards to oral administration, dosage ranged from<50 mg/d (n ¼ 1), 11 50 mg/d (n ¼ 2), 14,16 and >50 mg/d (n ¼ 3).…”