Clinical Trials Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2015; 4(3): 251-257
Published online Aug 4, 2015. doi: 10.5492/wjccm.v4.i3.251
Landiolol, an ultra-short-acting β1-blocker, is useful for managing supraventricular tachyarrhythmias in sepsis
Masaki Okajima, Masayuki Takamura, Takumi Taniguchi
Masaki Okajima, Takumi Taniguchi, Intensive Care Unit, Kanazawa University Hospital, Kanazawa 920-8641, Japan
Masayuki Takamura, Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medicine, Kanazawa 920-8641, Japan
Author contributions: Okajima M, Takamura M and Taniguchi T contributed to this manuscript.
Institutional review board statement: The study was reviewed and approved by the Kanazawa University Hospital Institutional Review Board.
Clinical trial registration: This study is registered at http://www.controlled-trials.com/isrctn/. The registration identification number is ISRCTN 70831305.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors state that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at masaki46228@m-kanazawa.jp.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaki Okajima, MD, PhD, Intensive Care Unit, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa 920-8641, Japan. masaki46228@m-kanazawa.jp
Telephone: +81-76-2652000 Fax: +81-76-2344339
Received: August 22, 2014
Peer-review started: August 22, 2014
First decision: September 28, 2014
Revised: April 15, 2015
Accepted: April 27, 2015
Article in press: April 29, 2015
Published online: August 4, 2015
Processing time: 360 Days and 17.1 Hours
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: Landiolol; Supraventricular tachyarrhythmias; Sepsis; Rate control; Conversion to sinus rhythm

Core tip: The management of tachyarrhythmia is important but it is often difficult because of unstable hemodynamics in septic patients. Landiolol is an ultra-short-acting β1 selective adrenoceptor antagonist. It exerts a more potent negative chronotropic effect and a lesser effect on blood pressure than other β blockers. In fact, landiolol significantly reduced heart rate without any deterioration of hemodynamics in this study. The most impressive finding is high conversion rate to sinus rhythm immediately after landiolol administration. Landiolol could control not only heart rate but also cardiac rhythm in septic patients with supraventricular tachyarrhythmias. Landiolol safely reduced heart rate and, in part, converted to sinus rhythm in septic patients with supraventricular tachyarrhythmia. Landiolol could be a valuable and suitable drug for managing supraventricular tachyarrhythmias in patients with sepsis.