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Levy B, Slama M, Lakbar I, Maizel J, Kato H, Leone M, Okada M. Landiolol for Treatment of New-Onset Atrial Fibrillation in Critical Care: A Systematic Review. J Clin Med 2024; 13:2951. [PMID: 38792492 PMCID: PMC11122541 DOI: 10.3390/jcm13102951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background: new-onset atrial fibrillation remains a common complication in critical care settings, often necessitating treatment when the correction of triggers is insufficient to restore hemodynamics. The treatment strategy includes electric cardioversion in cases of hemodynamic instability and either rhythm control or rate control in the absence of instability. Landiolol, an ultrashort beta-blocker, effectively controls heart rate with the potential to regulate rhythm. Objectives This review aims to compare the efficacy of landiolol in controlling heart rate and converting to sinus rhythm in the critical care setting. Methods: We conducted a comprehensive review of the published literature from 2000 to 2022 describing the use of landiolol to treat atrial fibrillation in critical care settings, excluding both cardiac surgery and medical cardiac care settings. The primary outcome assessed was sinus conversion following landiolol treatment. Results: Our analysis identified 17 publications detailing the use of landiolol for the treatment of 324 critical care patients. While the quality of the data was generally low, primarily comprising non-comparative studies, landiolol consistently demonstrated similar efficacy in controlling heart rate and facilitating conversion to sinus rhythm in both non-surgical (75.7%) and surgical (70.1%) settings. The incidence of hypotension associated with landiolol use was 13%. Conclusions: The use of landiolol in critical care patients with new-onset atrial fibrillation exhibited comparable efficacy and tolerance in both non-surgical and surgical settings. Despite these promising results, further validation through randomized controlled trials is necessary.
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Affiliation(s)
- Bruno Levy
- Service de Médecine Intensive et Réanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Université de Lorraine, 54511 Vandœuvre-lès-Nancy, France
| | - Michel Slama
- Intensive Care Unit, Amiens Picardie University Hospital, 80054 Amiens, France; (M.S.); (J.M.)
| | - Ines Lakbar
- Department of Anesthesiology and Intensive Care Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13385 Marseille, France; (I.L.); (M.L.)
| | - Julien Maizel
- Intensive Care Unit, Amiens Picardie University Hospital, 80054 Amiens, France; (M.S.); (J.M.)
| | - Hiromi Kato
- Department of Anesthesiology and Intensive Care, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France;
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13385 Marseille, France; (I.L.); (M.L.)
| | - Motoi Okada
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan;
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Floria M, Oancea AF, Morariu PC, Burlacu A, Iov DE, Chiriac CP, Baroi GL, Stafie CS, Cuciureanu M, Scripcariu V, Tanase DM. An Overview of the Pharmacokinetics and Pharmacodynamics of Landiolol (an Ultra-Short Acting β1 Selective Antagonist) in Atrial Fibrillation. Pharmaceutics 2024; 16:517. [PMID: 38675178 PMCID: PMC11054558 DOI: 10.3390/pharmaceutics16040517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Landiolol is an ultra-short-acting, selective β1-adrenergic receptor blocker that was originally approved in Japan for the treatment of intraoperative tachyarrhythmias. It has gained attention for its use in the management of tachyarrhythmias and perioperative tachycardia, especially atrial fibrillation for both cardiac and non-cardiac surgeries. It can be the ideal agent for heart rate control due to its high β1-selectivity, potent negative chronotropic effect, a limited negative inotropic potential, and an ultrashort elimination half-life (around 4 min); moreover, it may have a potential therapeutic effects for sepsis and pediatric patients. Landiolol seems to be superior to other short-acting and selective beta-blockers such as esmolol. This review aims to provide a comprehensive overview of landiolol, a new ultra-short-acting β1 selective antagonist, including its pharmacology, clinical applications, efficacy, safety profile, and future directions in research and clinical data.
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Affiliation(s)
- Mariana Floria
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.F.); (A.B.); (D.E.I.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania; (C.P.C.); (G.L.B.)
| | - Alexandru Florinel Oancea
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.F.); (A.B.); (D.E.I.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania; (C.P.C.); (G.L.B.)
| | - Paula Cristina Morariu
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.F.); (A.B.); (D.E.I.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania; (C.P.C.); (G.L.B.)
| | - Alexandru Burlacu
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.F.); (A.B.); (D.E.I.); (D.M.T.)
- Cardiovascular Disease Institute, 700503 Iasi, Romania
| | - Diana Elena Iov
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.F.); (A.B.); (D.E.I.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania; (C.P.C.); (G.L.B.)
| | | | - Genoveva Livia Baroi
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania; (C.P.C.); (G.L.B.)
- Department of Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Celina Silvia Stafie
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Magdalena Cuciureanu
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Viorel Scripcariu
- Department of Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.F.); (A.B.); (D.E.I.); (D.M.T.)
- Saint Spiridon Emergency Hospital, 700115 Iasi, Romania; (C.P.C.); (G.L.B.)
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Kimura D, Yamamoto H, Endo S, Fukuchi E, Miyata H, Fukuda I, Ogino H, Sawa Y, Chida M, Minakawa M. Postoperative cerebral infarction and arrhythmia after pulmonary lobectomy in Japan: a retrospective analysis of 77,060 cases in a national clinical database. Surg Today 2023; 53:1388-1395. [PMID: 37147511 DOI: 10.1007/s00595-023-02691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/03/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To investigate the incidence of postoperative cerebral infarction after curative lobectomy, its association with the type of lobectomy, and how postoperative new-onset arrhythmia contributes to postoperative cerebral infarction. METHODS The subjects of this analysis were 77,060 patients who underwent curative lobectomy for lung cancer between 2016 and 2018 according to the National Clinical Database. Incidences of postoperative cerebral infarction and postoperative new-onset arrhythmia were analyzed. Moreover, mediation analysis was performed to evaluate the causal pathway between postoperative new-onset arrhythmia and postoperative cerebral infarction. RESULTS Postoperative cerebral infarction occurred in 110 (0.7%) patients after left upper lobectomy and in 85 (0.7%) patients after left lower lobectomy. Left upper lobectomy and left lower lobectomy were associated with a higher likelihood of postoperative cerebral infarction than right lower lobectomy. Left upper lobectomy was the strongest independent predictor of postoperative new-onset arrhythmia. However, in the mediation analysis, the odds ratio for cerebral infarction did not change after the addition of the factor of postoperative new-onset arrhythmia. CONCLUSION Cerebral infarction occurred significantly more often not only after left upper lobectomy, but also after left lower lobectomy. Postoperative new-onset arrhythmia was less likely to be related to cerebral infarction after left upper lobectomy.
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Affiliation(s)
- Daisuke Kimura
- The Japanese Association for Thoracic Surgery, Tokyo, Japan.
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shunsuke Endo
- The Japanese Association for Thoracic Surgery, Tokyo, Japan
- Department of Thoracic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Eriko Fukuchi
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ikuo Fukuda
- The Japanese Association for Thoracic Surgery, Tokyo, Japan
- Cardiovascular Center, Suita Tokushukai Hospital, Osaka, Japan
| | - Hitoshi Ogino
- The Japanese Association for Thoracic Surgery, Tokyo, Japan
- Department of Cardiovascular Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yoshiki Sawa
- The Japanese Association for Thoracic Surgery, Tokyo, Japan
- Osaka Police Hospital, Osaka, Japan
| | - Masayuki Chida
- The Japanese Association for Thoracic Surgery, Tokyo, Japan
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Masahito Minakawa
- The Japanese Association for Thoracic Surgery, Tokyo, Japan
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Yamamoto H, Hamasaki T, Onda K, Nojiri T, Aragaki M, Horie N, Sato N, Hida Y. Landiolol, an ultra-short acting beta-1 blocker, for preventing postoperative lung cancer recurrence: study protocol for a phase III, multicenter randomized trial with two parallel groups of patients. Trials 2019; 20:715. [PMID: 31829248 PMCID: PMC6907139 DOI: 10.1186/s13063-019-3904-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Recurrence of cancer after curative surgery is a major problem after most cancer treatments. Increased sympathetic activity during the perioperative period could promote cancer cell invasion to blood vessels and angiogenesis, resulting in cancer metastasis. Recent studies showed that use of beta blockers can be associated with the prolonged survival of patients with cancer. The objective of this study is to evaluate the preventive effects of landiolol hydrochloride, which is an ultra-short-acting beta-1-selective blocker that has been developed in Japan, on reducing recurrence of cancer after curative surgery for patients with lung cancer. Methods The present study is a phase III, multicenter, randomized trial with two parallel groups of patients with lung cancer, comparing surgery alone and surgery with landiolol administration for three days during the perioperative period. A total of 400 patients will be enrolled from 12 Japanese institutions. The primary endpoint is two-year relapse-free survival and overall survival after curative surgery for lung cancer. The secondary endpoints are additional treatment after recurrence of cancer, safety events, and the incidence of postoperative complications. Discussion The principal question addressed in this trial is whether landiolol can reduce recurrence of cancer after curative surgery for lung cancer. Trial registration Japan Registry of Clinical Trials, jRCT2011180004. Registered 17 January 2019.
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Affiliation(s)
- Haruko Yamamoto
- National Cerebral and Cardiovascular Center, 6-1, Kishibeshimmachi, Suita, Osaka, 564-8565, Japan.
| | - Toshimitsu Hamasaki
- National Cerebral and Cardiovascular Center, 6-1, Kishibeshimmachi, Suita, Osaka, 564-8565, Japan
| | - Kaori Onda
- National Cerebral and Cardiovascular Center, 6-1, Kishibeshimmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Nojiri
- Higashiosaka City Medical Center, Higashiosaka, Osaka, Japan
| | | | - Nao Horie
- Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Norihiro Sato
- Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yasuhiro Hida
- Hokkaido University Hospital, Sapporo, Hokkaido, Japan
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Abstract
Beta-blockers are a potential option to manage peri-operative atrial fibrillation. Landiolol is a new ultra-short beta-blocker with a half-life of only 4 minutes and very high beta-1 selectivity which has been used for treatment and prevention of atrial fibrillation in pulmonary surgery and gastro-intestinal surgery. Due to its limited negative inotropic effect and high beta-1 selectivity landiolol allows for control of heart rate with minimal impact on blood pressure. Landiolol is well tolerated by the respiratory system. Additional benefits are related to the regulation of the inflammatory response and blunting of the adrenergic pathway. There is a limited number of trials with total of 61 patients undergoing lung resection or oesophagectomy who developed post-operative atrial fibrillation and were treated with landiolol. The experience with landiolol for prevention is more documented than landiolol application for treatment of post-operative atrial fibrillation. There are 9 comparative studies with a total of 450 patients administered landiolol for prevention of post-operative atrial fibrillation. The use of low dosage (5-10mcg/kg/min) is usually sufficient to rapidly control heart rate which is associated with earlier and higher rate of conversion to sinus rhythm as compared to the controls. The excellent tolerance of landiolol at lower dosage (3-5mcg/kg/min) allows to initiate prophylactic use during surgery and postoperatively. Landiolol prophylaxis is associated with reduced incidence of post-operative atrial fibrillation without triggering adverse events related to a beta-blockade.
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Affiliation(s)
- Martin Balik
- Department of Anaesthesia and Intensive Care, 1st Medical Faculty, Charles University, General University Hospital, U Nemocnice 2, Praha 2, Czechia
| | - Michael Sander
- Universitätsklinikum Gießen, Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Rudolf-Buchheim-Straße 7, Gießen, Deutschland
| | - Helmut Trimmel
- Abteilung für Anästhesie, Notfall- und Allg. Intensivmedizin Landesklinikum, Wiener Neustadt Corvinusring 3-5, Wiener Neustadt, Österreich
| | - Gottfried Heinz
- Abteilung für Kardiologie-Intensivstation 13H3, AKH Wien, Währinger Gürtel 18-20, Wien, Österreich
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Horikoshi Y, Goyagi T, Kudo R, Kodama S, Horiguchi T, Nishikawa T. The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia, and plasma IL-6 elevation in patients undergoing esophageal surgery: A randomized controlled clinical trial. J Clin Anesth 2017; 38:111-116. [PMID: 28372647 DOI: 10.1016/j.jclinane.2017.01.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/12/2017] [Accepted: 01/21/2017] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To determine whether perioperative landiolol administration suppresses postoperative atrial fibrillation (AF) and the plasma cytokines elevation in patients undergoing esophageal cancer surgery. DESIGN A prospective, randomized controlled trial. SETTING Akita University Hospital, Akita, Japan, from April 2012 to January 2015. PATIENTS Forty American Society of Anesthesiologists grade I-II patients undergoing elective esophagectomy. INTERVENTIONS Patients were randomly divided into two groups, landiolol group (landiolol: 5μg/kg/min) and control group (the same volume of covered saline). Landiolol or saline was infused continuously from the induction of anesthesia until next morning. MEASUREMENTS We examined the new onset of AF and sinus tachycardia, and measured plasma concentrations of cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α) just before surgery, at the end of surgery, the next day, and 2days after surgery. Data (mean±SD) were analyzed using two-way ANOVA followed by the Bonferroni"s test for post hoc comparison; a P<0.05 was considered statistically significant. MAIN RESULTS Demographic data were similar between the landiolol and the control groups. The incidence of AF was significantly lower in the landiolol group (1/19=5.3%) compared with the control group (7/20=35%) as well as sinus tachycardia (landiolol group, 0/19=0% vs. control group, 5/20=25%). Plasma IL-6 level at the end of surgery was significantly lower in the landiolol group compared with the control group, but the other plasma cytokines levels were similar between the two groups during the entire study period. CONCLUSIONS Perioperative landiolol administration suppressed the incidence of new-onset of AF as well as sinus tachycardia, and the plasma IL-6 elevation in patients undergoing esophageal cancer surgery.
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Affiliation(s)
- Yuta Horikoshi
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Toru Goyagi
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan.
| | - Ryohei Kudo
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Sahoko Kodama
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Takashi Horiguchi
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshiaki Nishikawa
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
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Plosker GL. Landiolol: a review of its use in intraoperative and postoperative tachyarrhythmias. Drugs 2014; 73:959-77. [PMID: 23760735 DOI: 10.1007/s40265-013-0077-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Landiolol (Onoact(®)) is an intravenously administered, ultra short-acting β1-blocker with an elimination half-life of 3-4 min and ≈8-fold greater cardioselectivity than esmolol in vitro. It is approved in Japan for the treatment of intraoperative and postoperative tachyarrhythmias, but in clinical practice is also used to prevent postoperative tachyarrhythmias, such as atrial fibrillation after coronary artery bypass grafting. Randomized controlled trials in patients undergoing open-heart surgery demonstrated that various dosages of landiolol (0.0005-0.04 mg/kg/min) [0.5-40 μg/kg/min] were more effective than diltiazem in converting postoperative atrial fibrillation to normal sinus rhythm during the first 8 h after surgery, and were more effective than placebo (or no landiolol) in preventing the development of atrial fibrillation during the first week after surgery (primary efficacy endpoints). In patients undergoing surgical procedures, landiolol 0.125 mg/kg/min for 1 min followed by 0.04 mg/kg/min for 10 min was superior to placebo in improving intraoperative tachycardia in randomized double-blind trials. The beneficial effects of landiolol in attenuating adverse haemodynamic or other changes that can occur during surgery or invasive procedures (e.g. percutaneous coronary intervention) have been demonstrated in a large number of randomized controlled trials. For example, several studies showed that landiolol attenuated the increase in heart rate associated with tracheal intubation, without adversely affecting blood pressure or other haemodynamic parameters. Landiolol was generally well tolerated in clinical trials, with a relatively low risk of hypotension and bradycardia, although routine monitoring of cardiac function during landiolol administration is important. In general, adverse events such as reduced blood pressure resolve quickly after discontinuation of landiolol. Thus, as an ultra short-acting β1-blocker with a rapid onset of action and readily titratable and rapidly reversible effects, landiolol represents an important agent for the management of intraoperative and postoperative tachyarrhythmias.
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Affiliation(s)
- Greg L Plosker
- Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand.
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