Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 13;24(Suppl D):D34-D42.
doi: 10.1093/eurheartjsupp/suac025. eCollection 2022 Jun.

Short acting intravenous beta-blocker as a first line of treatment for atrial fibrillation after cardiac surgery: a prospective observational study

X Chapalain  1 , J F Oilleau  1 , L Henaff  1 , P Lorillon PharmD  2 , D Le Saout  1 , P Kha  1 , K Pluchon  3 , E Bezon  3 , O Huet  1
Affiliations

Short acting intravenous beta-blocker as a first line of treatment for atrial fibrillation after cardiac surgery: a prospective observational study

X Chapalain et al. Eur Heart J Suppl. .

Abstract

Post-operative atrial fibrillation (POAF) defined as a new-onset of atrial fibrillation (AF) following surgery occurs frequently after cardiac surgery. For non-symptomatic patients, rate control strategy seems to be as effective as rhythm control one in surgical patients. Landiolol is a new highly cardio-selective beta-blocker agent with interesting pharmacological properties that may have some interest in this clinical situation. This is a prospective, monocentric, observational study. All consecutive adult patients (age >18 years old) admitted in the intensive care unit following cardiac surgery with a diagnosed episode of AF were eligible. Success of landiolol administration was defined by a definitive rate control from the beginning of infusion to the 72th h. We also evaluated rhythm control following landiolol infusion. Safety analysis was focused on haemodynamic, renal and respiratory side effects. From 1 January 2020 to 30 June 2021, we included 54 consecutive patients. A sustainable rate control was obtained for 49 patients (90.7%). Median time until a sustainable rate control was 4 h (1, 22). Median infusion rate of landiolol needed for a sustainable rate control was 10 µg/kg/min (6, 19). Following landiolol infusion, median time until pharmacological cardioversion was 24 h. During landiolol infusion, maintenance of mean arterial pressure target requires a concomitant very low dose of norepinephrine. We did not find any other side effects. Low dose of landiolol used for POAF treatment was effective and safe for a rapid and sustainable rate and rhythm control after cardiac surgery.

Keywords: Beta-blocker; Cardiac surgery; Landiolol; Post-operative atrial fibrillation; Rate control.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study standardized management of post-operative atrial fibrillation.
Figure 2
Figure 2
Percentage of rate and rhythm control during landiolol infusion from the initiation to the 72th h. (A) Proportion and number of patients with a sustainable rate control. (B) Proportion and number of patients with first rate control. (C) Proportion and number of patients with conversion to sinus rhythm.
Figure 3
Figure 3
Trend of the main haemodynamic parameters. We reported mean values and confidence interval (CI 95%) from the beginning of landiolol infusion to the 72th h. (A) Mean landiolol infusion rate (µg/kg/min) over time. (B) Heart rate (b.p.m.) changes over time. (C) Mean norepinephrine infusion rate (µg/kg/min), number/proportion of patients who needed norepinephrine over time. (D) Mean arterial pressure (mmHg) changes over time.
See this image and copyright information in PMC

References

    1. Eikelboom R, Sanjanwala R, Le M-L, Yamashita MH, Arora RC. Postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis. Ann Thorac Surg 2021;111:544–554. - PubMed
    1. Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg 2017;52:665–672. - PubMed
    1. Gillinov AM, Bagiella E, Moskowitz AJ, Raiten JM, Groh MA, Bowdish ME, Ailawadi G, Kirkwood KA, Perrault LP, Parides MK, Smith RL, Kern JA, Dussault G, Hackmann AE, Jeffries NO, Miller MA, Taddei-Peters WC, Rose EA, Weisel RD, Williams DL, Mangusan RF, Argenziano M, Moquete EG, O’Sullivan KL, Pellerin M, Shah KJ, Gammie JS, Mayer ML, Voisine P, Gelijns AC, O’Gara PT, Mack MJ. Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med 2016;374:1911–1921. - PMC - PubMed
    1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan G-A, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau J-P, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL, ESC Scientific Document Group . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373–498. - PubMed
    1. Syed YY. Landiolol: a review in tachyarrhythmias. Drugs 2018;78:377–388. - PubMed