Abstract 13382: Urgent Control of Rapid Atrial Tachyarrhythmia Using Landiolol in Patients With Heart Failure With Severely Reduced Ejection Fraction : An Ultra-Short-Acting β-blocker for Emergency ADHF

Abstract

Backgounds: To control heart rate(HR) of atrial tachyarrhythmia is important in patients with acute decompensated heart failure(ADHF) in their critical phase. Landiolol is newly developed an ultra-short-acting β-blocker. We explored the hemodynamic effect of Landiolol treatment for atrial tachyarrhythmia in patients with ADHF in their critical phase. Hypothesis: Landiolol is useful to control HR of atrial tachyarrhythmia without any adverse events and it can make their status better. Methods: Consecutive 35 ADHF patients were enrolled(74 years, 25 men, EF25%, HR137/min, BNP837pg/ml). 34 out of 35 patients had atrial fibrillation (AF) or atrial flutter (AFL), and one patient had atrial tachcardia (AT). We treated them with low dose landiolol immediately after admission. Among them, 17 patients were monitored by Swan-Ganz (S-G) catheterization to explore the hemodynamic effect of Landiolol. Results: The average maximum dose of Landiolol was 3.3γ. No patients had serious adverse events. HR (93/min, p<0.0001) and BNP (618pg/ml, p<0.05 ) decreased after treatment and In S-G data, PCWP and PAP decreased after Landiolol treatment, on the other hand CO increased. Three patients out of 17 patients with S-G could not achieve adequate HR decrease (110<min) even with their maximum dose, their ΔHR were -28, -28, +1/min.. They had higher PCWP (32 vs 20, p<0.05) and relatively lower CO (2.7 vs 3.0, NS) compared with responders. One patient had AT and his HR didn’t decrease (ΔHR= +1/min) and hemodynamic condition didn't improve. Conclusions: Low dose Landiolol that is an ultra-short-acting β-blocker, was effective for controlling rapid HR in AF/AFL patients with LV dysfunction despite being in the critical state. The patients with extremely severe condition and atrial tachycardia might not be suitable for Landiolol treatment in their critical states.