School of Medicine and Surgery, University of Pavia, Pavia, Italy.
Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
ESC Heart Fail. 2022 Feb;9(1):766-770. doi: 10.1002/ehf2.13763. Epub 2021 Dec 27.
Tachycardia and rapid tachyarrhythmias are common in acute clinical settings and may hasten the deterioration of haemodynamics in patients with acute decompensated heart failure (ADHF), treated with inotropes. The concomitant use of a short-acting β1-selective beta-blocker, such as landiolol, could rapidly and safely restore an adequate heart rate without any negative inotropic effect. We present a case series of five patients with left ventricular dysfunction, admitted to our Intensive Cardiac Care Unit with ADHF deteriorated to cardiogenic shock, treated with a combination of landiolol and inotropes. Landiolol was effective in terms of rate control and haemodynamics optimization, enabling de-escalation of catecholamine dosing in all patients. The infusion was always well tolerated without hypotension. In conclusion, a continuous infusion of a low dose of landiolol (3-16 mcg/kg/min) to manage tachycardia and ventricular or supraventricular tachyarrhythmias in haemodynamically unstable patients may be considered.
心动过速和快速性心律失常在急性临床环境中很常见，可能会加速正在接受正性肌力药物治疗的急性失代偿性心力衰竭（ADHF）患者的血液动力学恶化。同时使用短效β1-选择性β受体阻滞剂，如拉贝洛尔，可以在不产生负性肌力作用的情况下快速、安全地恢复适当的心率。我们报告了 5 例左心室功能障碍患者的病例系列，这些患者因 ADHF 恶化至心源性休克而入住我们的重症心脏监护病房，接受拉贝洛尔和正性肌力药物联合治疗。拉贝洛尔在控制心率和优化血液动力学方面非常有效，使所有患者的儿茶酚胺剂量逐渐减少。输注始终耐受良好，无低血压。总之，对于血流动力学不稳定的患者，可考虑使用低剂量（3-16mcg/kg/min）的拉贝洛尔持续输注来控制心动过速和室性或室上性心动过速。
