Iwahashi Noriaki, Takahashi Hironori, Abe Takeru, Okada Kozo, Akiyama Eiichi, Matsuzawa Yasushi, Konishi Masaaki, Maejima Nobuhiko, Hibi Kiyoshi, Kosuge Masami, Ebina Toshiaki, Tamura Kouichi, Kimura Kazuo
Division of Cardiology, Yokohama City University Medical Center Yokohama Japan.
Department of Emergency Medicine, Yokohama City University Medical Center Yokohama Japan.
Circ Rep. 2019 Sep 26;1(10):422-430. doi: 10.1253/circrep.CR-19-0076.
We investigated the clinical usefulness of landiolol for rapid atrial fibrillation (AF) in patients with acute decompensated heart failure (ADHF) and identify the patients eligible for landiolol. A total of 101 ADHF patients with reduced ejection fraction (HFrEF) with rapid AF were enrolled. Immediately after admission, an initial dose of landiolol was given (1 μg/kg/min), and then the dose was increased to decrease heart rate (HR) to <110 beats/min and change HR (∆HR) >20% in ≤24 h. Thirty-seven were monitored using right heart catheterization at 3 points (baseline, 1 μg/kg/min, and maximum dose). We checked the major adverse events (MAE) during initial hospitalization, which included cardiac death, HF prolongation (required i.v. treatment at 30 days), and worsening renal function. The average maximum dose of landiolol was 3.8±2.3 μg/kg/min. HR (P<0.0001) and pulmonary capillary wedge pressure (P=0.0008) decreased safely. MAE occurred in 39 patients. The patients with left ventricular (LV) end-diastolic volume index <84.0 mL/m and mean blood pressure (mean BP) >97 mmHg had less frequent MAE (P<0.0001). Landiolol was effective for safely controlling rapid AF in patients with HFrEF with ADHF, leading to hemodynamic improvement and avoidance of short-term MAE, especially in patients with relatively smaller LV and higher BP.
我们研究了兰地洛尔对急性失代偿性心力衰竭（ADHF）患者快速心房颤动（AF）的临床疗效，并确定适合使用兰地洛尔的患者。共纳入101例射血分数降低（HFrEF）且伴有快速AF的ADHF患者。入院后立即给予兰地洛尔初始剂量（1μg/kg/min），然后增加剂量以使心率（HR）降至<110次/分钟，并在≤24小时内使HR变化（∆HR）>20%。37例患者在3个时间点（基线、1μg/kg/min和最大剂量）使用右心导管进行监测。我们检查了初始住院期间的主要不良事件（MAE），包括心源性死亡、心力衰竭延长（30天内需静脉治疗）和肾功能恶化。兰地洛尔的平均最大剂量为3.8±2.3μg/kg/min。HR（P<0.0001）和肺毛细血管楔压（P=0.0008）安全下降。39例患者发生MAE。左心室（LV）舒张末期容积指数<84.0 mL/m且平均血压（平均BP）>97 mmHg的患者MAE发生率较低（P<0.0001）。兰地洛尔可有效安全地控制HFrEF合并ADHF患者的快速AF，改善血流动力学并避免短期MAE，尤其是在LV相对较小且BP较高的患者中。
