Intravenous Landiolol for Rate Control in Supraventricular Tachyarrhythmias in Patients with Left Ventricular Dysfunction: A Systematic Review and Meta-Analysis

Abstract

Background: This systematic review explores the effects of landiolol administration in individuals presenting with supraventricular tachyarrhythmia (SVT) and concurrent left ventricular dysfunction, without being septic or in a peri-operative period. Methods: We systematically searched PubMed, Cochrane, Web of Science, and Scopus databases, retrieving a total of 15 eligible studies according to prespecified eligibility criteria. Results: Patients treated with landiolol experienced a substantial reduction in heart rate (HR) (mean HR reduction: 42 bpm, 95% confidence intervals (CIs): 37-47, I² = 82%) and were more likely to achieve the target HR compared to those receiving alternative antiarrhythmic therapy (pooled odds ratio (OR): 5.37, 95% CIs: 2.87-10.05, I² = 0%). Adverse events, primarily hypotension, occurred in 14.7% of patients receiving landiolol, but no significant difference was observed between the landiolol and alternative antiarrhythmic receiving groups (pooled OR: 1.02, 95% CI: 0.57-1.83, I² = 0%). No significant difference was observed between the two groups concerning sinus rhythm restoration (pooled OR: 0.97, 95% CI: 0.25-3.78, I² = 0%) and drug discontinuation due to adverse events (pooled OR: 5.09, 95% CI: 0.6-43.38, I² = 0%). Conclusion: While further research is warranted, this systematic review highlights the potential benefits of landiolol administration in the management of SVTs in the context of left ventricular dysfunction.

Keywords: arrhythmia; atrial fibrillation; atrial flutter; beta-blocker; heart failure; landiolol; rate control; supraventricular; tachycardia; ventricular dysfunction.

Figure 1

PRISMA 2020 flow diagram.

Figure 2

Forest plot of the mean heart rate reduction achieved with landiolol administration. Green dots represent the mean HR decrease of each study. The black diamond represents the overall mean HR reduction from all included studies [18,19,20,21,24,26,27,28,29,32,33].

Figure 3

(A) Forest plot of comparison in target HR achievement rates between landiolol and non-landiolol treated groups Blue squares represent the mean Odds ratio for target HR achievement of each study and the black diamond represents the overall pooled Odds ratio for target HR achievement from all the included studies [18,19]; (B) Forest plot of comparison in sinus rhythm restoring rates between landiolol and non-landiolol treated groups. Blue squares represent the mean Odds ratio for SR restoration of each study and the black diamond represents the overall pooled Odds ratio for SR restoration from the included studies [18,19].

Figure 4

(A) Forest plot of the systolic blood pressure reduction after landiolol treatment. Green squares represent the mean SBP decrease of each study. The black diamond represents the overall mean SBP decrease from the included studies [18,20,24,26,27]; (B) Forest plot of the diastolic blood pressure reduction after landiolol treatment. Green squares represent the mean DBP decrease of each study. The black diamond represents the overall mean DBP decrease from the included studies [18,20,26].

Figure 5

(A) Forest plot of comparison in the rates of adverse events or subjective symptoms report in landiolol and non-landiolol treated groups. The blue squares represent the Odds ratio of adverse events/subjective symptoms from each study. The black diamond represents the overall pooled Odds ratio of adverse events/subjective symptoms from the included studies [18,19]; (B) Forest plot of comparison in the rates of adverse events leading to drug discontinuation in landiolol and non-landiolol treated groups. The blue squares represent the Odds ratio of adverse events leading to drug discontinuation of each study. The black diamond represents the overall pooled Odds ratio of adverse events leading to drug discontinuation from all included studies [18,19].