Kiuchi Shunsuke, Aikawa Hiroto, Hisatake Shinji, Kabuki Takayuki, Oka Takashi, Dobashi Shintaro, Fujii Takahiro, Ikeda Takanori
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
J Clin Med Res. 2017 May;9(5):426-432. doi: 10.14740/jocmr2954w. Epub 2017 Apr 1.
Patients with acute heart failure (HF) complicated by supraventricular tachyarrhythmia (SVT) often receive continuous intravenous infusion of landiolol or diltiazem for rate control. It is unclear whether the interval from initiation of infusion to commencement of oral beta-blocker (BB) therapy differs for these two drugs.
From January 2013 to July 2015, 94 consecutive patients were hospitalized for acute HF complicated by SVT. After 35 patients were excluded, the remaining 59 were divided into groups treated with diltiazem or landiolol. We investigated the blood pressure, heart rate, New York Heart Association classification, brain natriuretic peptide, chest X-ray film, echocardiographic findings (ejection fraction (EF)), time until commencement of oral BB therapy, and hospital stay.
There were no significant between-group differences of heart rate, blood pressure, or the severity of HF. The time until commencing oral BB therapy was significantly shorter in the landiolol group compared with the diltiazem group (median: 2 vs. 4 days, P = 0.002), but there was no significant difference in hospital stay. This interval was significantly shorter in patients with a reduced EF in the landiolol group (median: 2 days) compared with those with a reduced EF in the diltiazem group (median: 5 days, P = 0.008), and patients with a preserved EF in the landiolol group tended to have a shorter interval (median: 2 days) than those with a preserved EF in the diltiazem group (median: 4 days, P = 0.092).
Switching to oral BBs was accomplished earlier with landiolol than with diltiazem.
急性心力衰竭（HF）合并室上性快速心律失常（SVT）的患者常接受静脉持续输注兰地洛尔或地尔硫䓬以控制心率。目前尚不清楚这两种药物从开始输注到开始口服β受体阻滞剂（BB）治疗的间隔时间是否存在差异。
2013年1月至2015年7月，94例因急性HF合并SVT住院的患者。排除35例患者后，将其余59例分为地尔硫䓬组或兰地洛尔组进行治疗。我们调查了血压、心率、纽约心脏协会分级、脑钠肽、胸部X线片、超声心动图检查结果（射血分数（EF））、开始口服BB治疗的时间以及住院时间。
两组在心率、血压或HF严重程度方面无显著差异。与地尔硫䓬组相比，兰地洛尔组开始口服BB治疗的时间显著缩短（中位数：2天对4天，P = 0.002），但住院时间无显著差异。兰地洛尔组中EF降低的患者此间隔时间显著短于地尔硫䓬组中EF降低的患者（中位数：2天对5天，P = 0.008），兰地洛尔组中EF保留的患者此间隔时间也倾向于短于地尔硫䓬组中EF保留的患者（中位数：2天对4天，P = 0.092）。
与地尔硫䓬相比，兰地洛尔能更早地转换为口服BB治疗。
