Landiolol, an ultra-short-acting β1-blocker, is useful for managing supraventricular tachyarrhythmias in sepsis

Abstract

Aim: To investigate whether landiolol, an ultra-short-acting β1-antagonist, can safely and effectively control heart rate in septic patients with supraventricular tachyarrhythmias.

Methods: We reviewed all patients with sepsis who admitted to our intensive care unit between January 2006 and December 2011. Sixty one septic patients suffered from supraventricular tachyarrhythmias (heart rate ≥ 120 bpm for > 1 h). Among 61 patients, 39 patients were treated with landiolol (landiolol group) and 22 patients were not treated with landiolol (control group). Arterial pressure, heart rate, cardiac rhythm, pulmonary arterial pressure and cardiac output (if a pulmonary arterial catheter was inserted) were compared between the 2 groups at 1, 8 and 24 h after the initiation of tachyarrhythmias.

Results: Mean age and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were similar between the 2 groups. Paroxysmal atrial fibrillation/flutter (87%), paroxysmal atrial tachycardia (10%), and paroxysmal supraventricular tachycardia (3%) were observed. The initial landiolol dose administered was 6.3 ± 5.8 g/kg per minute. Rapid and substantial reduction of heart rate was observed in the landiolol group without any deterioration of hemodynamics. Landiolol significantly reduced heart rate (from 145 ± 14 bpm to 90 ± 20 bpm) compared to the control group (from 136 ± 21 bpm to 109 ± 18 bpm, P < 0.05). The conversion to sinus rhythm was observed more frequently in the landiolol group than in the control group at every point (P < 0.01 at 8 h; P < 0.05 at 1 and 24 h).

Conclusion: Landiolol safely reduced heart rate and, in part, converted to sinus rhythm in septic patients with supraventricular tachyarrhythmias.

Keywords: Conversion to sinus rhythm; Landiolol; Rate control; Sepsis; Supraventricular tachyarrhythmias.

Figure 1

Heart rate and sinus rhythm conversion rate. Rapid and substantial reduction of heart rate (HR) was observed in the landiolol group. Reduction in HR was observed in the landiolol group than the control. In addition, the conversion from supraventricular arrhythmia to sinus rhythm was observed more frequently in the landiolol group than in the control group at every point. Results are expressed as mean ± SE. ^aP < 0.01, ^bP < 0.05 vs time 0 h.

Figure 2

Arterial pressure. Landiolol did not change atrial blood pressure. Results are expressed as mean ± SE.

Figure 3

Pulmonary arterial catheter parameters. Landiolol did not affect diastolic pulmonary arterial pressure or cardiac index. Results are expressed as mean ± SE.