The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia, and plasma IL-6 elevation in patients undergoing esophageal surgery: A randomized controlled clinical trial

Horikoshi, Yuta; Goyagi, Toru; Kudo, Ryohei; Kodama, Sahoko; Horiguchi, Takashi; Nishikawa, Toshiaki

doi:10.1016/j.jclinane.2017.01.036

Cited by 32 publications

(23 citation statements)

References 46 publications

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“…22 Horikoshi et al administered landiolol at 5 μg/kg/ min from the induction of anesthesia until the morning of POD 1 and use of landiolol significantly reduced the incidence of POAF (incidence: landiolol: 5.3% vs placebo: 35%, p<0.05) and also sinus tachycardia (incidence: landiolol: 0% vs placebo: 25%, p<0.05). 23 Moreover, they evaluated postoperative inflammation cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α) and use of landiolol significantly suppressed IL-6 elevation but not other cytokines. From these RCT results, one study found no superiority for prophylactic usage, but this study suffered from low statistical power and other studies showed significance in preventing POAF.…”

Section: Role Of Prophylactic Landiolol In Non-cardiac Surgeriesmentioning

confidence: 99%

<p>Evaluating the Therapeutic Efficacy and Safety of Landiolol Hydrochloride for Management of Arrhythmia in Critical Settings: Review of the Literature</p>

Matsuishi¹,

Mathis²,

Shimojo³

et al. 2020

VHRM

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Background: Landiolol hydrochloride, a highly cardio-selective beta-1 blocker with an ultra-short-acting half-life of 4 minutes, was originally approved by Japan for treatment of intraoperative tachyarrhythmias. This review aims to provide an integrated overview of the current state of knowledge of landiolol hydrochloride in the management of arrhythmia in critical settings. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library to retrieve relevant articles with a total of 65 records identified. Results: The high β1 selectivity (β1/β2 ratio of 255:1) of landiolol causes a more rapid heart rate (HR) decrease compared to esmolol while avoiding decreases in mean arterial blood pressure. Recently, it has been found useful in left ventricular dysfunction patients and fatal arrhythmia requiring emergency treatment. Recent random clinical trials (RCT) have revealed therapeutic and prophylactic effects on arrhythmia, and very low-dose landiolol might be effective for preventing postoperative atrial fibrillation (POAF) and sinus tachycardia. Likewise, landiolol is an optimal choice for perioperative tachycardia treatment during cardiac surgery. The high β1 selectivity of landiolol is useful in heart failure patients as a first-line therapy for tachycardia and arrhythmia as it avoids the typical depression of cardiac function seen in other β-blockers. Application in cardiac injury after percutaneous coronary intervention (PCI), protection for vital organs (lung, kidney, etc.) during sepsis, and stabilizing hemodynamics in pediatric patients are becoming the new frontier of landiolol use. Conclusion: Landiolol is useful as a first-line therapy for the prevention of POAF after cardiac/non-cardiac surgery, fatal arrhythmias in heart failure patients and during PCI. Moreover, the potential therapeutic effect of landiolol for sepsis in pediatric patients is currently being explored. As positive RCT results continue to be published, new clinical uses and further clinical studies in various settings by cardiologists, intensivists and pediatric cardiologists are being conducted.

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Section: Role Of Prophylactic Landiolol In Non-cardiac Surgeriesmentioning

confidence: 99%

<p>Evaluating the Therapeutic Efficacy and Safety of Landiolol Hydrochloride for Management of Arrhythmia in Critical Settings: Review of the Literature</p>

Matsuishi¹,

Mathis²,

Shimojo³

et al. 2020

VHRM

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“…This significant difference at end of surgery was also observed in another study with infusion covering intraoperative period and continued until the next morning, but with no difference in IL-6 levels at POD1 and POD2. 31 Conversely, when landiolol infusion was started on POD1, IL-6 levels were significantly lower when measured on POD3 and POD5, but not at POD1.…”

Section: Perspectivesmentioning

confidence: 92%

“…One study reported a low incidence of hypotension (3%) which resolved quickly upon reducing dose. 24 In general, most studies reported no bradycardia and no hypotension 17 , 24 , 30 , 31 or respiratory symptoms 26 with no need to decrease dose or stop the infusion.…”

Section: Landiolol Use To Prevent Post-operative Atrial Fibrillationmentioning

confidence: 98%

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Landiolol for managing post-operative atrial fibrillation

Borggrefe

Sander

Trimmel

et al. 2018

European Heart Journal Supplements

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Beta-blockers are a potential option to manage peri-operative atrial fibrillation. Landiolol is a new ultra-short beta-blocker with a half-life of only 4 minutes and very high beta-1 selectivity which has been used for treatment and prevention of atrial fibrillation in pulmonary surgery and gastro-intestinal surgery. Due to its limited negative inotropic effect and high beta-1 selectivity landiolol allows for control of heart rate with minimal impact on blood pressure. Landiolol is well tolerated by the respiratory system. Additional benefits are related to the regulation of the inflammatory response and blunting of the adrenergic pathway. There is a limited number of trials with total of 61 patients undergoing lung resection or oesophagectomy who developed post-operative atrial fibrillation and were treated with landiolol. The experience with landiolol for prevention is more documented than landiolol application for treatment of post-operative atrial fibrillation. There are 9 comparative studies with a total of 450 patients administered landiolol for prevention of post-operative atrial fibrillation. The use of low dosage (5-10mcg/kg/min) is usually sufficient to rapidly control heart rate which is associated with earlier and higher rate of conversion to sinus rhythm as compared to the controls. The excellent tolerance of landiolol at lower dosage (3-5mcg/kg/min) allows to initiate prophylactic use during surgery and postoperatively. Landiolol prophylaxis is associated with reduced incidence of post-operative atrial fibrillation without triggering adverse events related to a beta-blockade.

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“…The authors should be congratulated for performing a welldesigned study on an important topic (cancer recurrence and mortality) in patients undergoing urologic procedures [2,3]. The current emphasis to reduce potential perioperative factors that can result in cancer recurrence makes the topic very relevant in perioperative medicine [4,5].…”

mentioning

confidence: 99%

Re: Marc A. Furrer, Adrian Fellmann, Marc P. Schneider, George N. Thalmann, Fiona C. Burkhard, Patrick Y. Wuethrich. Impact of Packed Red Blood Cells and Fresh Frozen Plasma Given During Radical Cystectomy and Urinary Diversion on Cancer-related Outcome and Survival: An Observational Cohort Study. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2017.09.010

Kendall¹

2019

European Urology Focus

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The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia, and plasma IL-6 elevation in patients undergoing esophageal surgery: A randomized controlled clinical trial

Cited by 32 publications

References 46 publications

<p>Evaluating the Therapeutic Efficacy and Safety of Landiolol Hydrochloride for Management of Arrhythmia in Critical Settings: Review of the Literature</p>

<p>Evaluating the Therapeutic Efficacy and Safety of Landiolol Hydrochloride for Management of Arrhythmia in Critical Settings: Review of the Literature</p>

Landiolol for managing post-operative atrial fibrillation

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