Landiolol reduces heart rate in patients with ATs, left ventricular dysfunction

Use of landiolol, a highly selective and short-acting beta-1 blocker, demonstrates adequate safety and efficacy in terms of heart rate control among patients suffering from atrial tachyarrhythmias (ATs) and left ventricular (LV) dysfunction, suggest the results of a meta-analysis presented at EHRA 2024.

“ATs are frequently inter-related with heart failure (HF),” said lead author Dr Athina Nasoufidou from Aristotle University of Thessaloniki, Second Cardiology Department, Thessaloniki, Greece. “ATs exacerbate HF, while the existence of chronic HF precipitates the occurrence of ATs.”

Nasoufidou and her team examined the clinical effects of rate control with landiolol in patients with ATs and comorbid LV dysfunction, who were not septic or in perioperative stage. They systematically searched the databases of PubMed, Scopus, and Web of Science through 14 July 2023.

Two independent reviewers performed the screening and selection of randomized controlled trials (RCTs) and observational studies using predetermined eligibility criteria. The investigators then evaluated the quality of evidence and risk of bias based on Cochrane guidelines.

A total of 2,278 articles were identified after the search, of which 15 were included in the systematic review. Of the 15 studies, 11 met the eligibility criteria: seven studies compared landiolol with placebo and four compared the study drug with other antiarrhythmic drugs, particularly digoxin and diltiazem. [Nasoufidou A, et al, EHRA 2024]

Overall, 1,876 patients comprised the combined sample size, of whom 75 percent had a New York Heart Association (NYHA) classification of III or IV, indicating moderate or severe HF symptoms.

Treatment with landiolol resulted in a reduction in the patients’ heart rate (mean 42 beats per minute [bpm], 95 percent confidence interval [CI], 37‒47). In addition, three of four treated patients achieved their targeted heart rate, defined as at least 20-percent decrease from baseline heart rate and final heart rate <110 bpm.

Likewise, patients treated with landiolol were more likely to achieve the target heart rate (odds ratio, 5.32, 95 percent CI, 2.87‒10.05) than those treated with other antiarrythmic agents.

“In single-arm studies, landiolol managed to decrease heart rate for a mean of 42 bpm, and 75 percent of patients achieved the targeted heart rate, which meant a 20-percent reduction from the initial heart rate,” Nasoufidou said. “This target was set by the largest RCT of the included studies.”

“Compared to other antiarryhthmic drugs, digoxin and diltiazem, landiolol [presented] superior efficacy in target heart rate achievement, with an odds ratio of 5.32 in favour of landiolol,” she added.

With regard to safety, adverse events (AEs) occurred in 15 percent of patients who received landiolol. The most common AE was dose-dependent hypotension. However, AEs did not differ significantly between landiolol and the other antiarrhythmic drugs. Only 6 percent of the treated patients discontinued the use of landiolol.

“In conclusion, landiolol proved good efficacy and safety for heart rate control in patients with ATs and LV dysfunction,” Nasoufidou said.