Matsuishi Yujiro, Mathis Bryan J, Shimojo Nobutake, Kawano Satoru, Inoue Yoshiaki
Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Medical English Communication Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Vasc Health Risk Manag. 2020 Apr 3;16:111-123. doi: 10.2147/VHRM.S210561. eCollection 2020.
Landiolol hydrochloride, a highly cardio-selective beta-1 blocker with an ultra-short-acting half-life of 4 minutes, was originally approved by Japan for treatment of intraoperative tachyarrhythmias. This review aims to provide an integrated overview of the current state of knowledge of landiolol hydrochloride in the management of arrhythmia in critical settings.
We searched MEDLINE, EMBASE, and the Cochrane Library to retrieve relevant articles with a total of 65 records identified.
The high β1 selectivity (β1/β2 ratio of 255:1) of landiolol causes a more rapid heart rate (HR) decrease compared to esmolol while avoiding decreases in mean arterial blood pressure. Recently, it has been found useful in left ventricular dysfunction patients and fatal arrhythmia requiring emergency treatment. Recent random clinical trials (RCT) have revealed therapeutic and prophylactic effects on arrhythmia, and very low-dose landiolol might be effective for preventing postoperative atrial fibrillation (POAF) and sinus tachycardia. Likewise, landiolol is an optimal choice for perioperative tachycardia treatment during cardiac surgery. The high β1 selectivity of landiolol is useful in heart failure patients as a first-line therapy for tachycardia and arrhythmia as it avoids the typical depression of cardiac function seen in other β-blockers. Application in cardiac injury after percutaneous coronary intervention (PCI), protection for vital organs (lung, kidney, etc.) during sepsis, and stabilizing hemodynamics in pediatric patients are becoming the new frontier of landiolol use.
Landiolol is useful as a first-line therapy for the prevention of POAF after cardiac/non-cardiac surgery, fatal arrhythmias in heart failure patients and during PCI. Moreover, the potential therapeutic effect of landiolol for sepsis in pediatric patients is currently being explored. As positive RCT results continue to be published, new clinical uses and further clinical studies in various settings by cardiologists, intensivists and pediatric cardiologists are being conducted.
盐酸兰地洛尔是一种高度心脏选择性的β1受体阻滞剂，半衰期超短，仅4分钟，最初由日本批准用于治疗术中快速性心律失常。本综述旨在全面概述盐酸兰地洛尔在危重症心律失常管理方面的现有知识状态。
我们检索了MEDLINE、EMBASE和Cochrane图书馆，以获取相关文章，共识别出65条记录。
与艾司洛尔相比，兰地洛尔的高β1选择性（β1/β2比率为255:1）可使心率（HR）下降更快，同时避免平均动脉血压下降。最近发现它对左心室功能不全患者和需要紧急治疗的致命性心律失常有用。近期的随机临床试验（RCT）揭示了其对心律失常的治疗和预防作用，极低剂量的兰地洛尔可能对预防术后房颤（POAF）和窦性心动过速有效。同样，兰地洛尔是心脏手术围手术期心动过速治疗的最佳选择。兰地洛尔的高β1选择性对心力衰竭患者作为心动过速和心律失常的一线治疗很有用，因为它避免了其他β受体阻滞剂常见的心脏功能抑制。在经皮冠状动脉介入治疗（PCI）后心脏损伤中的应用、脓毒症期间对重要器官（肺、肾等）的保护以及儿科患者血流动力学的稳定正成为兰地洛尔使用的新领域。
兰地洛尔作为心脏/非心脏手术后预防POAF、心力衰竭患者和PCI期间致命性心律失常的一线治疗是有用的。此外，目前正在探索兰地洛尔对儿科患者脓毒症的潜在治疗作用。随着RCT阳性结果不断发表，心脏病专家、重症监护医生和儿科心脏病专家正在进行各种情况下的新临床应用和进一步临床研究。
