Do the Efficacy and Safety of Treatment with Landiolol, an Ultra-short-acting β1-Selective Blocker, Differ in the Urgent Management of Rapid Atrial Fibrillation between Patients Complicated with Cardiac Versus Non-cardiac Disease?

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  • KAMIJO Hiroshi
    Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine
  • KASHIMA Yuichiro
    Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine
  • TAKESHIGE Kanako
    Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine
  • NITTA Kenichi
    Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine
  • IMAMURA Hiroshi
    Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine

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  • Do the Efficacy and Safety of Treatment with Landiolol, an Ultra-short-acting <i>β</i>1-Selective Blocker, Differ in the Urgent Management of Rapid Atrial Fibrillation between Patients Complicated with Cardiac Versus Non-cardiac Disease ?

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Purpose : Atrial fibrillation (AF) is highly prevalent in patients with non-cardiac diseases and in patients with cardiac disease. However, only a few studies have evaluated the characteristics of patients with AF complicated with non-cardiac diseases. We aimed to investigate whether the safety and efficacy of landiolol, an ultra-shortacting β1-selective blocker for controlling rapid heart rate (HR), for patients with AF differed between those with cardiac disease and those with non-cardiac diseases.<br>Materials and Methods : All AF patients with HRs≥ 120 beats/min who received continuous intravenous landiolol administration were included in this study (n＝133). The patients were divided into the cardiac (n＝55) and non-cardiac (n＝78) disease groups. Successful HR control was defined as an HR<110 beats/min and a ≥ 20％ decrease in HR in 2 hr after landiolol initiation.<br>Results : Landiolol significantly decreased the HRs of patients with rapid AF in both groups (cardiac : 145±17 to 103±22 beats/min, P<0.001 ; non-cardiac : 145±18 to 114±23 beats/min ; P<0.001). The proportion of patients achieving the efficacy endpoint was higher in the cardiac group than in the non-cardiac group (58.2％, n＝32 vs. 35.9％, n＝28 ; P＝0.02). No intergroup difference was noted in the incidence of adverse events. C-reactive protein levels were independent factors associated with non-effective landiolol responses (odds ratio : OR, 0.958 ; 95％ CI, 0.920－0.997 ; P＝0.04). A non-effective landiolol response was significantly and independently associated with 30-day mortality (Hazard ratios : HzR, 5.043 ; 95％ CI, 1.516-16.777 ; P<0.01).<br>Conclusions : Landiolol may be a therapeutic option for the acute control of rapid AF in patients with either cardiac or non-cardiac complications, especially in those without marked inflammation.

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