Second Department of Internal Medicine, Toyama University, Toyama, Japan.
ESC Heart Fail. 2020 Oct;7(5):2208-2213. doi: 10.1002/ehf2.12879. Epub 2020 Jul 14.
While patients with acute heart failure often have tachycardia with atrial fibrillation, there have been no established medical tools that control tachycardia safely and definitely. Digoxin has been recommended as a first choice in the former guidelines, but it takes time to affect and has a risk of adverse events particularly for those with chronic kidney disease. Landiolol is a recently innovated ultra-short-acting beta-blocker with 251-fold β1/β2 selectivity, which was originally indicated only to control peri-operative supra-ventricular tachyarrhythmia by 2013 in Japan. We aimed to review how to use landiolol in patients with cardiac dysfunction and tachycardia due to atrial fibrillation. We reviewed recently conducted randomized control trials using landiolol, recently updated guidelines, as well as current practical use of landiolol. Japan landiolol vs. Digoxin (J-Land) study demonstrated that landiolol was more effective to control tachycardia than digoxin in atrial fibrillation patients with left ventricular dysfunction in 2013. Given the result, the revised Japanese heart failure guideline recommends landiolol for rate control during atrial fibrillation in acute heart failure patients as Class IIa with evidence level B. Currently in Japan, landiolol is used for rate control, even in patients with advanced heart failure receiving continuous infusion of inotropes. The clinical use of landiolol in patients with cardiac dysfunction and tachycardia due to atrial fibrillation is increasing. Further studies are warranted to investigate the implication of faster and safer rate control using landiolol.
虽然急性心力衰竭患者常有心律过速伴心房颤动，但目前尚无安全、明确控制心动过速的既定医疗手段。地高辛曾被推荐作为前指南中的首选药物，但它需要时间起效，且对慢性肾脏病患者尤其有发生不良事件的风险。拉多洛尔是一种最近创新的超短效β受体阻滞剂，具有 251 倍的β1/β2选择性，最初仅在 2013 年在日本被批准用于控制围手术期室上性心动过速。我们旨在回顾如何在因心房颤动而出现心功能障碍和心动过速的患者中使用拉多洛尔。我们回顾了最近使用拉多洛尔进行的随机对照试验、最近更新的指南以及目前拉多洛尔的实际应用。2013 年，日本拉多洛尔与地高辛（J-Land）研究表明，在左心室功能障碍的心房颤动患者中，拉多洛尔控制心动过速的效果优于地高辛。鉴于这一结果，修订后的日本心力衰竭指南建议在急性心力衰竭患者的心房颤动期间将拉多洛尔作为 IIa 类药物用于控制心率，证据水平为 B。目前在日本，即使在接受连续输注正性肌力药物的晚期心力衰竭患者中，也使用拉多洛尔控制心率。拉多洛尔在因心房颤动而出现心功能障碍和心动过速的患者中的临床应用正在增加。需要进一步的研究来探讨使用拉多洛尔更快、更安全地控制心率的意义。
