Heart and Vessels

, Volume 29, Issue 4, pp 464–469 | Cite as

Novel use of the ultra-short-acting intravenous β1-selective blocker landiolol for supraventricular tachyarrhythmias in patients with congestive heart failure

  • Toru Adachi
  • Akira SatoEmail author
  • Masako Baba
  • Daigo Hiraya
  • Tomoaki Hasegawa
  • Kenji Kuroki
  • Tomoya Hoshi
  • Kazutaka Aonuma
Original Article


The purpose of this study was to find a safe dosing regimen for landiolol, an ultra-short-acting β-adrenergic blocking agent, to rapidly control supraventricular tachyarrhythmias (SVTs) in patients with heart failure (HF). Landiolol is reported to have good effects in the treatment of SVTs after cardiac surgery. We evaluated 52 patients with SVT and symptoms of HF (NYHA class III/IV, 10/42; EF 32 ± 12 %) on admission because of ischaemic disease (n = 10), non-ischaemic cardiomyopathy (n = 32), or valvular disease (n = 10). Paroxysmal/persistent atrial fibrillation and atrial tachycardia were present in 16 (30 %), 23 (45 %), and 13 (25 %) patients, respectively. The patients first underwent conventional therapy with carperitide, dobutamine, or milrinone. Intravenous landiolol was administered at an infusion rate of 1 μg/kg/min and, if no adverse effects developed, the maintenance dose, titrated to HR and blood pressure response, was increased. At an average dose of 10.8 ± 9.4 μg/kg/min, mean HR significantly decreased significantly from 133 ± 27 to 82 ± 15 beats/min (P < 0.01), whereas systolic blood pressure did not differ from baseline to attainment of an effective dose level (105 ± 21 vs. 101 ± 19 mmHg, P = ns). Within 60 min after initiation of therapy, all patients had achieved a 20 % reduction in HR at the maintenance dose. Transient asymptomatic hypotension requiring cessation of landiolol therapy occurred in three patients. Intravenous administration of landiolol was both effective in rapidly controlling HR for up to 24 h and useful as bridging treatment to additional therapy of oral β blockade, pulmonary vein catheter ablation, or cardiac resynchronisation therapy in patients with HF.


Landiolol Supraventricular tachyarrhythmias Heart failure 


Conflict of interest

No conflicts of interest exist.


  1. 1.
    Nohria A, Lewis E, Stevenson LW (2002) Medical management of advanced heart failure. JAMA 287:628–640PubMedCrossRefGoogle Scholar
  2. 2.
    Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98:946–952PubMedCrossRefGoogle Scholar
  3. 3.
    Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW (1998) Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 32:695–703PubMedCrossRefGoogle Scholar
  4. 4.
    Hamaguchi S, Yokoshiki H, Kinugawa S, Tsuchihashi-Makaya M, Yokota T, Takeshita A, Tsutsui H (2009) Effects of atrial fibrillation on long-term outcomes in patients hospitalized for heart failure in Japan: a report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 73:2084–2090PubMedCrossRefGoogle Scholar
  5. 5.
    Mathew J, Hunsberger S, Fleg J, Mc Sherry F, Williford W, Yusuf S (2000) Incidence, predictive factors, and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure. Chest 118:914–922PubMedCrossRefGoogle Scholar
  6. 6.
    Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 107:2920–2925PubMedCrossRefGoogle Scholar
  7. 7.
    Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, Bourassa MG, Arnold JM, Buxton AE, Camm AJ, Connolly SJ, Dubuc M, Ducharme A, Guerra PG, Hohnloser SH, Lambert J, Le Heuzey JY, O’Hara G, Pedersen OD, Rouleau JL, Singh BN, Stevenson LW, Stevenson WG, Thibault B, Waldo AL, Atrial Fibrillation and Congestive Heart Failure Investigators (2008) Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 358:2667–2677PubMedCrossRefGoogle Scholar
  8. 8.
    Ishii S, Inomata T, Ikeda Y, Nabeta T, Iwamoto M, Watanabe I, Naruke T, Shinagawa H, Koitabashi T, Nishii M, Takeuchi I, Izumi T (2013) Clinical significance of heart rate during acute decompensated heart failure to predict left ventricular reverse remodeling and prognosis in response to therapies in nonischemic dilated cardiomyopathy. Heart Vessel. doi: 10.1007/s00380-013-0335-0 Google Scholar
  9. 9.
    Crystal E, Connolly SJ, Sleik K, Ginger TJ, Yusuf S (2002) Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation 106:75–80PubMedCrossRefGoogle Scholar
  10. 10.
    Sugiyama A, Takahara A, Hashimoto K (1999) Electrophysiologic, cardiohemodynamic and beta-blocking actions of a new ultra-short-acting beta-blocker, ONO-1101, assessed by the in vivo canine model in comparison with esmolol. J Cardiovasc Pharmacol 34:70–77PubMedCrossRefGoogle Scholar
  11. 11.
    Sasao J, Tarver SD, Kindscher JD, Taneyama C, Benson KT, Goto H (2001) In rabbits, landiolol, a new ultra-short-acting beta-blocker, exerts a more potent negative chronotropic effect and less effect on blood pressure than esmolol. Can J Anaesth 48:985–989PubMedCrossRefGoogle Scholar
  12. 12.
    Sezai A, Minami K, Nakai T, Hata M, Yoshitake I, Wakui S, Shiono M, Hirayama A (2011) Landiolol hydrochloride for prevention of atrial fibrillation after coronary artery bypass grafting: new evidence from the PASCAL trial. J Thorac Cardiovasc Surg 141:1478–1487PubMedCrossRefGoogle Scholar
  13. 13.
    Nishi H, Sakaguchi T, Miyagawa S, Yoshikawa Y, Fukushima S, Saito S, Ueno T, Kuratani T, Sawa Y (2012) Efficacy of landiolol hydrochloride for atrial fibrillation after open heart surgery. Heart Vessel. doi: 10.1007/s00380-012-0263-4 Google Scholar
  14. 14.
    Hoshi T, Sato A, Nishina H, Kakefuda Y, Wang Z, Noguchi Y, Aonuma K (2012) Acute hemodynamic effects of landiolol, an ultra-short-acting beta-blocker, in patients with acute coronary syndrome: preliminary study. J Cardiol. 60:252-6Google Scholar
  15. 15.
    Kobayashi S, Susa T, Tanaka T, Murakami W, Fukuta S, Okuda S, Doi M, Wada Y, Nao T, Yamada J, Okamura T, Yano M, Matsuzaki M (2012) Low-dose β-blocker in combination with milrinone safely improves cardiac function and eliminates pulsus alternans in patients with acute decompensated heart failure. Circ J 76:1646–1653PubMedCrossRefGoogle Scholar
  16. 16.
    Goto K, Shingu C, Miyamoto S, Miyakawa H, Noguchi T (2007) The effect of landiolol on hemodynamics and left ventricular function in patients with coronary artery disease. J Clin Anesth 19:523–529PubMedCrossRefGoogle Scholar
  17. 17.
    Gray RJ, Bateman TM, Czer LS, Conklin CM, Matloff JM (1985) Esmolol: a new ultrashort-acting beta-adrenergic blocking agent for rapid control of heart rate in postoperative supraventricular tachyarrhythmias. J Am Coll Cardiol 5:1451–1456PubMedCrossRefGoogle Scholar
  18. 18.
    Gray RJ. Managing critically ill patients with esmolol (1988) An ultra short-acting beta-adrenergic blocker. Chest 93:398–403Google Scholar
  19. 19.
    Ko WJ, Chu SH (1994) A new dosing regimen for esmolol to treat supraventricular tachyarrhythmia in Chinese patients. J Am Coll Cardiol 23:302–306PubMedCrossRefGoogle Scholar
  20. 20.
    Intravenous digoxin in acute atrial fibrillation (1997) Results of a randomized, placebo-controlled multicentre trial in 239 patients. The Digitalis in Acute Atrial Fibrillation (DAAF) Trial Group. Eur Heart J 18:649–654CrossRefGoogle Scholar
  21. 21.
    Tisdale JE, Padhi ID, Goldberg AD, Silverman NA, Webb CR, Higgins RS, Paone G, Frank DM, Borzak S (1998) A randomized, double-blind comparison of intravenous diltiazem and digoxin for atrial fibrillation after coronary artery bypass surgery. Am Heart J 135:739–747PubMedCrossRefGoogle Scholar
  22. 22.
    Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL, American College of Cardiology/American Heart Association Task Force on Practice Guidelines, European Society of Cardiology Committee for Practice Guidelines, European Heart Rhythm Association, Heart Rhythm Society (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines: developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114:e257–e354PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Toru Adachi
    • 1
  • Akira Sato
    • 1
    Email author
  • Masako Baba
    • 1
  • Daigo Hiraya
    • 1
  • Tomoaki Hasegawa
    • 1
  • Kenji Kuroki
    • 1
  • Tomoya Hoshi
    • 1
  • Kazutaka Aonuma
    • 1
  1. 1.Cardiovascular Division, Faculty of MedicineUniversity of TsukubaTsukubaJapan

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