Matsui Yuko, Suzuki Atsushi, Shiga Tsuyoshi, Arai Kotaro, Hagiwara Nobuhisa
Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Drugs Real World Outcomes. 2019 Mar;6(1):19-26. doi: 10.1007/s40801-019-0149-1.
Atrial tachyarrhythmias (ATAs) lead to clinical deterioration and worsening heart failure (HF) in patients with acute decompensated HF (ADHF). We evaluated the effects of the ultrashort-acting intravenous β1-blocker landiolol on the heart rate, hemodynamics, and outcome in patients with ATAs and ADHF.
A total of 67 consecutive hospitalized patients with ATAs and ADHF who were treated with landiolol (36 males, 67 ± 12 years) were included in this single-center retrospective study. The primary endpoints were changes in heart rate and systolic blood pressure from baseline during intravenous landiolol administration. The secondary endpoints included restoration of sinus rhythm and outcomes.
The median maintenance dose of intravenous landiolol was 3.0 (range 1.0-12.0) μg/kg/min and the median treatment duration was 5 (range 1-24) days. Intravenous landiolol reduced heart rate (141 ± 17 beats/min at baseline to 99 ± 20 beats/min at 6 h, P < 0.001) without a marked reduction in blood pressure or deterioration of HF. During landiolol treatment, 15 (22%) patients had spontaneously restored sinus rhythm. Eight patients experienced in-hospital death, and 41 (69%) were discharged with sinus rhythm. During the follow-up of 16 ± 12 months, patients with sinus rhythm showed a lower frequency of rehospitalization due to worsening HF than patients with ATAs (5/41 vs. 7/18, P = 0.019).
Our results showed that intravenous landiolol reduces the heart rate without markedly decreasing blood pressure in patients with ATAs and ADHF. Approximately 70% of the discharged patients were in sinus rhythm, and these patients showed a lower frequency of rehospitalization due to worsening HF (UMIN-CTR no. UMIN000033650).
房性快速性心律失常（ATA）会导致急性失代偿性心力衰竭（ADHF）患者临床状况恶化及心力衰竭（HF）加重。我们评估了超短效静脉用β1受体阻滞剂兰地洛尔对ATA和ADHF患者心率、血流动力学及预后的影响。
本单中心回顾性研究纳入了67例连续住院的接受兰地洛尔治疗的ATA和ADHF患者（男性36例，年龄67±12岁）。主要终点为静脉输注兰地洛尔期间心率和收缩压相对于基线的变化。次要终点包括窦性心律恢复情况及预后。
静脉用兰地洛尔的中位维持剂量为3.0（范围1.0 - 12.0）μg/kg/min，中位治疗持续时间为5（范围1 - 24）天。静脉用兰地洛尔降低了心率（基线时为141±17次/分钟，6小时时为99±20次/分钟，P < 0.001），且血压无明显降低，HF也未恶化。在兰地洛尔治疗期间，15例（22%）患者自发恢复了窦性心律。8例患者院内死亡，41例（69%）出院时为窦性心律。在16±12个月的随访期间，窦性心律患者因HF恶化再次住院的频率低于ATA患者（5/41 vs. 7/18，P = 0.019）。
我们的结果表明，静脉用兰地洛尔可降低ATA和ADHF患者的心率，且血压无明显下降。约70%的出院患者为窦性心律，这些患者因HF恶化再次住院的频率较低（UMIN-CTR编号：UMIN000033650）。
