Optimal use of intravenous landiolol in acute cardiac care

ABSTRACT

Introduction

B-blockers are regarded as beneficial pharmacologic agents in cardiac care, but their role in the acute setting remains ambiguous. Increasing evidence supports the important role of landiolol in critical care, a highly cardioselective intravenous b-blocker with rapid onset of action and short elimination time. Among its most valuable properties, which may aid to overcome special reservations related to b-blocker therapy in the acute setting, landiolol has a potent negative chronotropic effect while at the same time it exhibits a mild negative inotropic effect.

Areas covered

This expert opinion review aims to present basic pharmacologic aspects of landiolol and provide current clinical research focused on its efficacy and safety.

Expert opinion

Landiolol is a valuable and safe pharmacologic agent in acute cardiac care. Japanese and European guidelines have incorporated its use for the management of atrial tachyarrhythmia in patients with cardiac dysfunction. Although emerging clinical trials have experimented its use in patients with sustained ventricular tachycardia/fibrillation, acute myocardial infarction undergoing primary percutaneous intervention and in patients with septic cardiomyopathy, more studies are needed in order to establish its value in such cardiac conditions.

KEYWORDS:

• Acute heart failure
• atrial fibrillation
• landiolol
• pharmacology
• percutaneous coronary intervention
• ventricular tachycardia/fibrillation
• septic cardiomyopathy
• β1-blocker1

Article highlights

• B-blocker therapy may be a valuable therapeutic strategy in the setting of acute cardiac conditions.

• Landiolol, a product of the chemical modification of esmolol, is a more potent and highly cardioselective β1-blocker with a very short elimination time that provides hemodynamic stability.

• Its effects may be exerted through various pathophysiological mechanisms, such as attenuated sympathetic activity and neurohormonal activation, improved calcium handling and diastolic filling, and amelioration of ischemia through reduced oxygen consumption and unaffected vasodilation in coronary blood vessels.

• The use of landiolol in patients with supraventricular arrhythmias and cardiac dysfunction was firstly introduced in 2013, by the J-land study, and based on extensive research is recommended by the latest Japanese and European guidelines.

• Recent evidence suggests its use in the management of ventricular arrhythmias, septic cardiomyopathy and acute coronary syndromes.

Declaration of interest

A Boultadakis has received honoraria for lectures from AOP Health and JT Parissis has received honoraria for lectures from AOP Health, Novartis, Orion Pharma, Pfizer, and Roche Diagnostics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.