Landiolol effective remedy for sepsis-related tachyarrhythmias: Lancet

The study is published in the Lancet.

Landiolol hydrochloride (landiolol) is an ultra-short-acting beta-1-selective blocker that has been developed in Japan, whose pharmacokinetics and pharmacodynamics profiles are similar to esmolol .

It is approved for emergency treatment of intraoperative and postoperative tachyarrhythmia and is used for supraventricular arrhythmia including atrial fibrillation/flutter (AF) after pulmonary resection for lung cancer treatment . Preventive effect of landiolol for postoperative AF after heart valve surgery and coronary artery bypass grafting have been reported. 

The authors conducted a multicentre, open-label, randomized controlled trial among 151 patients who were randomly divided into two groups - 76 to the landiolol group who received conventional sepsis therapy plus landiolol and 75 to the control group who were given only the conventional sepsis therapy. Patients, 20 years of age or older, who subsequently developed a tachyarrhythmia was admitted to the intensive care units for the purpose of the study.

The findings of the research was-

1. A significantly larger the proportion of patients in the landiolol group had a heart rate of 60–94 bpm 24 h after randomization than in the control group (55% [41 of 75] vs 33% [25 of 75]), with a between-group difference of 23·1%.
2. Adverse effects were observed in 64% of patients in the landiolol group and in 59% in the control group.
3. Serious adverse events related to landiolol occurred in five (6%) of 77 patients, including decreased blood pressure in three patients (4%) and cardiac arrest, heart rate decrease, and ejection fraction decrease occurred in one patient each (1%).

The Researchers concluded that Landiolol resulted in significantly more patients with sepsis-related tachyarrhythmia achieving a heart rate of 60–94 bpm at 24 h and significantly reduced the incidence of new-onset arrhythmia. Landiolol was also well tolerated, but it should be used under appropriate monitoring of blood pressure and heart rate owing to the risk of hypotension in patients with sepsis and septic shock.

This study was registered with the Japan Pharmaceutical Information Center Clinical Trials Information database, number JapicCTI-173767.

https://doi.org/10.1016/S2213-2600(20)30037-0