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. 2019 Jul 25;14(1):145.
doi: 10.1186/s13019-019-0966-z.

Use of low-dose β1-blocker for sinus tachycardia in patients with catecholamine support following cardiovascular surgery: a retrospective study

Michihiro Sakai  1 , Satoshi Jujo  2 , Junjiro Kobayashi  3 , Yoshihiko Ohnishi  2 , Masataka Kamei  4
Affiliations

Use of low-dose β1-blocker for sinus tachycardia in patients with catecholamine support following cardiovascular surgery: a retrospective study

Michihiro Sakai et al. J Cardiothorac Surg. .

Abstract

Background: Sinus tachycardia coupled with high-dose catecholamine is common after cardiopulmonary bypass (CPB). The present study assessed the hemodynamic efficacy and safety of combination therapy using low-dose β1-selective adrenergic blocker (landiolol) and inotropes.

Methods: This was a retrospective, single center, self-comparison study at post-anesthesia care unit within a tertiary care center. The study included adults who underwent cardiac surgery with CPB and received landiolol between April 2007 and November 2011. We assessed hemodynamic data prior to and 1 h after initiation of landiolol therapy.

Results: We evaluated 11 patients who were administered 2.6 ± 1.3 μg/kg/min (mean ± SD) landiolol with sinus tachycardia and received catecholamine therapy after on-pump cardiovascular surgery. Landiolol administration led to a significant reduction in heart rate (HR; 112.4 ± 5.8 vs 126.0 ± 7.6 beats/min, p < 0.001), and a significant increase in stroke volume index (SVI) assessed by pulmonary artery catheterization (22.4 ± 5.4 vs. 18.9 ± 4.2 mL/m2, p = 0.04). Only one patient showed no HR reduction, whereas seven patients showed decreased HR and increased SVI (64, 95% confidence interval: 30-98%). Moreover, all five patients who received high-dose catecholamine support showed improved hemodynamics. In terms of safety, no patients required cessation of landiolol therapy.

Conclusions: Low-dose landiolol therapy may safely decrease HR and improve hemodynamics among patients with sinus tachycardia receiving catecholamine treatment after cardiovascular surgery.

Trial registration: This study is retrospective. Registration number: 11. Duration of registration: April 2007~November 2011.

Keywords: Cardiovascular surgery; Catecholamine; Tachycardia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Relationship between change rates in heart rate reductions and stroke volume index increases for 11 patients. The following formula was used to calculate change rates: Change rate = (post-landiolol value – pre-landiolol value) / pre-landiolol value × 100 (%). Heart rate reduction showed a negative change rate. Closed circles indicate data from participants who received high-dose catecholamine support. The study treatment was considered clinically acceptable in terms of hemodynamic efficacy (one of the coprimary end points) (r = 0.7, p = 0.016). HR reduction, negative change rate of heart rate; SVI rise, change rate of stroke volume index
See this image and copyright information in PMC

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