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Cardiology. 2014;127(2):105-13. doi: 10.1159/000355312. Epub 2013 Nov 26.

A low-dose β1-blocker effectively and safely slows the heart rate in patients with acute decompensated heart failure and rapid atrial fibrillation.

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  • 1Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.

Abstract

OBJECTIVE:

Recently, we reported that low-dose landiolol (1.5 µg·kg(-1)·min(-1)), an ultra-short-acting β-blocker, safely decreased the heart rate (HR) in patients with acute decompensated heart failure (ADHF) and sinus tachycardia, thereby improving cardiac function. We investigated whether low-dose landiolol effectively decreased the HR in ADHF patients with rapid atrial fibrillation (AF).

METHODS:

We enrolled 23 ADHF patients with rapid AF (HR ≥120 beats·min(-1) and New York Heart Association class III-IV) and systolic heart failure (SHF: n = 12) or diastolic heart failure (DHF: n = 11) who received conventional therapy with diuretics, vasodilators, and/or low-dose inotropes. They were administered continuous intravenous infusion of low-dose landiolol (1.0-2.0 µg·kg(-1)·min(-1)), and their electrocardiograms and blood pressures were monitored for 24 h thereafter.

RESULTS:

Two hours after starting landiolol, the HR was reduced significantly (22%), without a reduction in blood pressure, and remained constant thereafter. The HR reduction 2 h after landiolol administration was significantly greater in the DHF group than in the SHF group. No incidence of hypotension was recorded.

CONCLUSIONS:

Digitalis or amiodarone is currently recommended for HR control in ADHF patients with rapid AF. Our results showed that continuous infusion of low-dose landiolol may also be useful as first-line therapy in these patients.

PMID:
24296610
DOI:
10.1159/000355312
[PubMed - indexed for MEDLINE]
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