Levosimendan (LS) is a novel calcium sensitiser which enhances cardiac contractility without increasing myocardial oxygen consumption, and induces vasodilation.

The effects of intravenous LS on cardiac arrhythmias in patients with moderate-to-severe heart failure were examined. The results of ambulatory electrocardiograms in 386 patients from 10 randomised, double-blind studies have been pooled (254 patients received LS and 132 patients received placebo).

No significant differences in baseline haemodynamic parameters were observed between the LS and placebo groups. Furthermore, mean 24-hour heart rate did not differ significantly between the two treatment groups (78 beats/min and 74 beats/min in LS and placebo groups, respectively). There were no differences in the occurrence or frequency of new supraventricular tachycardia (SVT), ventricular tachycardia (VT) or an increase in ventricular complexes (Morganroth's criteria) (Table 1). One patient in the placebo group experienced ventricular fibrillation, while no cases of torsades des pointes were observed with either treatment.

Table 1 Percentage of patients with supraventricular tachycardia (SVT), ventricular tachycardia (VT) or increase in premature ventricular complexes (PCV) after receiving levosimendan or placebo
Full size table

In conclusion, these data suggest that LS has little potential to induce life-threatening arrhythmias in patients with severe heart failure.