Beta-blockers are a potential option to manage peri-operative atrial fibrillation. Landiolol is a new ultra-short beta-blocker with a half-life of only 4 minutes and very high beta-1 selectivity which has been used for treatment and prevention of atrial fibrillation in pulmonary surgery and gastro-intestinal surgery. Due to its limited negative inotropic effect and high beta-1 selectivity landiolol allows for control of heart rate with minimal impact on blood pressure. Landiolol is well tolerated by the respiratory system. Additional benefits are related to the regulation of the inflammatory response and blunting of the adrenergic pathway. There is a limited number of trials with total of 61 patients undergoing lung resection or oesophagectomy who developed post-operative atrial fibrillation and were treated with landiolol. The experience with landiolol for prevention is more documented than landiolol application for treatment of post-operative atrial fibrillation. There are 9 comparative studies with a total of 450 patients administered landiolol for prevention of post-operative atrial fibrillation. The use of low dosage (5-10mcg/kg/min) is usually sufficient to rapidly control heart rate which is associated with earlier and higher rate of conversion to sinus rhythm as compared to the controls. The excellent tolerance of landiolol at lower dosage (3-5mcg/kg/min) allows to initiate prophylactic use during surgery and postoperatively. Landiolol prophylaxis is associated with reduced incidence of post-operative atrial fibrillation without triggering adverse events related to a beta-blockade.

Abteilung für Anästhesie Notfall und Allg Intensivmedizin Landesklinikum Wiener Neustadt Corvinusring 3 5 Wiener Neustadt Österreich

Abteilung für Kardiologie Intensivstation 13H3 AKH Wien Währinger Gürtel 18 20 Wien Österreich

Department of Anaesthesia and Intensive Care 1st Medical Faculty Charles University General University Hospital U Nemocnice 2 Praha 2 Czechia

Universitätsklinikum Gießen Klinik für Anästhesiologie Operative Intensivmedizin und Schmerztherapie Rudolf Buchheim Straße 7 Gießen Deutschland

Zobrazit více v PubMed

Imperatori A, Mariscalco G, Riganti G, Rotolo N, Conti V, Dominioni L.. Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study. J Cardiothorac Surg 2012;7:4.. PubMed PMC

Ivanovic J, Maziak DE, Ramzan S, McGuire AL, Villeneuve PJ, Gilbert S, Sundaresan RS, Shamji FM, Seely AJ.. Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection. Interact Cardiovasc Thorac Surg 2014;18:340–346. PubMed PMC

Raman T, Roistacher N, Liu J, Zhang H, Shi W, Thaler HT, Amar D.. Preoperative left atrial dysfunction and risk of postoperative atrial fibrillation complicating thoracic surgery. J Thorac Cardiovasc Surg 2012;143:482–487. PubMed

Amar D, Zhang H, Shi W, Downey RJ, Bains MS, Park BJ, Flores R, Rizk N, Thaler HT, Rusch VW.. Brain natriuretic peptide and risk of atrial fibrillation after thoracic surgery. J Thorac Cardiovasc Surg 2012;144:1249–1253. PubMed

Ojima T, Iwahashi M, Nakamori M, Nakamura M, Katsuda M, Iida T, Hayata K, Yamaue H.. Atrial fibrillation after esophageal cancer surgery: an analysis of 207 consecutive patients. Surg Today 2014;44:839–847. PubMed

Ciszewski P, Tyczka J, Nadolski J, Roszak M, Dyszkiewicz W.. Lower preoperative fluctuation of heart rate variability is an independent risk factor for postoperative atrial fibrillation in patients undergoing major pulmonary resection. Interact Cardiovasc Thorac Surg 2013;17:680–686. PubMed PMC

Schmidt HB, Werdan K, Muller-Werdan U.. Autonomic dysfunction in the ICU patient. Curr Opin Crit Care 2001;7:314–322.10.1097/00075198-200110000-00002 PubMed DOI

Murthy SC, Law S, Whooley BP, Alexandrou A, Chu KM, Wong J.. Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality. J Thorac Cardiovasc Surg 2003;126:1162–1167. PubMed

Chin J-H, Moon Y-J, Jo J-Y, Han YA, Kim HR, Lee E-H, Choi I-C, Lee H-S.. Association between postoperatively developed atrial fibrillation and long-term mortality after esophagectomy in esophageal cancer patients: an observational study. PLoS One 2016;11:e0154931.. PubMed PMC

Stawicki SP, Prosciak MP, Gerlach AT, Bloomston M, Davido HT, Lindsey DE, Dillhoff ME, Evans DC, Steinberg SM, Cook CH.. Atrial fibrillation after esophagectomy: an indicator of postoperative morbidity. Gen Thorac Cardiovasc Surg 2011;59:399–405. PubMed PMC

Lee SH, Ahn HJ, Yeon SM, Yang M, Kim JA, Jung DM, Park JH.. Potentially modifiable risk factors for atrial fibrillation following lung resection surgery: a retrospective cohort study. Anaesthesia 2016;71:1424–1430. PubMed

Ng EP, Velez-Cubian FO, Rodriguez KL, Thau MR, Moodie CC, Garrett JR, Fontaine JP, Toloza EM.. Surgical outcomes associated with postoperative atrial fibrillation after robotic-assisted pulmonary lobectomy: retrospective review of 208 consecutive cases. J Thorac Dis 2016;8:2079–2085. PubMed PMC

Tisdale JE, Wroblewski HA, Wall DS, Rieger KM, Hammoud ZT, Young JV, Kesler KA.. A randomized, controlled study of amiodarone for prevention of atrial fibrillation after transthoracic esophagectomy. J Thorac Cardiovasc Surg 2010;140:45–51. PubMed

Cardinale D, Sandri MT, Colombo A, Salvatici M, Tedeschi I, Bacchiani G, Beggiato M, Meroni CA, Civelli M, Lamantia G, Colombo N, Veglia F, Casiraghi M, Spaggiari L, Venturino M, Cipolla CM.. Prevention of atrial fibrillation in high-risk patients undergoing lung cancer surgery: the PRESAGE trial. Ann Surg 2016;264:244–251. PubMed

Cardinale D, Colombo A, Sandri MT, Lamantia G, Colombo N, Civelli M, Salvatici M, Veronesi G, Veglia F, Fiorentini C, Spaggiari L, Cipolla CM.. Increased perioperative N-terminal pro-B-type natriuretic peptide levels predict atrial fibrillation after thoracic surgery for lung cancer. Circulation 2007;115:1339–1344. PubMed

Ma JY, Wang Y, Zhao YF, Wu Z, Liu LX, Kou YL, Yang JJ.. Atrial fibrillation after surgery for esophageal carcinoma: clinical and prognostic significance. World J Gastroenterol 2006;12:449–452.10.3748/wjg.v12.i3.449 PubMed DOI PMC

Yagi K, Usuda J, Sakamoto A.. Perioperative landiolol infusion reduces the incidence of atrial fibrillation after pulmonary lobectomy: postoperative randomized controlled Study. Open J Anesthesiol 2016;6:119–123.10.4236/ojanes.2016.68020 DOI

Macchia A, Romero M, Comignani PD, Mariani J, D’Ettorre A, Prini N.. Previous prescription of beta-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis. Crit Care Med 2012;40:2768–2772. PubMed

Balik M, Kolnikova I, Maly M, Waldauf P, Tavazzi G, Kristof J.. Propafenone for supraventricular arrhythmias in septic shock-Comparison to amiodarone and metoprolol. J Crit Care 2017;41:16–23. PubMed

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K.. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016;18:1609–1678. PubMed

Nojiri T, Yamamoto K, Maeda H, Takeuchi Y, Funakoshi Y, Maekura R, Okumura M.. Efficacy of low-dose landiolol, an ultrashort-acting β-blocker, on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer. Gen Thorac Cardiovasc Surg 2011;59:799–805. PubMed

Nakano T, Shimizu K, Kawashima O, Kamiyoshihara M, Nagashima T, Ibe T, Takeyoshi I.. Effect of landiolol hydrochloride, an ultra-short-acting beta1-selective blocker, on supraventricular tachycardia, atrial fibrillation and flutter after pulmonary resection. J Clin Pharm Ther 2012;37:431–435. PubMed

Okita T, Uji M, Shinjo T, Morioka M, Kumano H, Ishimura N, Nishiwada M.. [Use of landiolol hydrochloride for the prevention of atrial fibrillation after lung resection]. Masui 2008;57:953–958. PubMed

Sugimoto R, Nakayama Y, Nawa Y, Orimo K, Yamakage M.. Administration of landiolol decreases the incidence of atrial fibrillation after lung lobectomy. Anesthesiology 2010; 18 October, A1141 (abstract).

Nezu N, Ogawa F, Matsui Y, Amano H, Hara H, Kurouzu N, Iyoda A, Satoh Y.. Effect of postoperative low-dose landiolol hydrochloride for the prevention of tachyarrhythmia after primary lung cancer surgery. J Jpn Assoc Chest Surg 2011;25:472–478.

Ito K, Nozaki M, Sakamoto R, Suzuki T, Masuda R, Iwazaki M.. Safety of landiolol infusion in patients undergoing lung resection. Open J Anesthesiol 2014;4:183–190.

Aoyama H, Otsuka Y, Aoyama Y.. Landiolol infusion during general anesthesia does not prevent postoperative atrial fibrillation in patients undergoing lung resection. Gen Thorac Cardiovasc Surg 2016;64:735–741.10.1007/s11748-016-0707-3 PubMed DOI

Niwa Y, Koike M, Iwata N, Kobayashi D, Tanaka C, Fujii T, Nakayama G, Sugimoto H, Fujiwara M, Kodera Y.. Effect of landiolol hydrochloride on tachyarrhythmia after esophagectomy. Hepatogastroenterology 2014;61:1546–1551. PubMed

Mori K, Yamada K, Fukuda T, Mitsui T, Kitamura T, Yamaguchi D, Ando J, Wada I, Nomura S, Shimizu N, Seto Y.. Landiolol hydrochloride for early postoperative tachycardia after transthoracic esophagectomy. Surg Today 2014;44:848–854. PubMed

Yoshida T, Furukita Y, Yamamoto Y, Nishino T, Inoue S, Morimoto M, Okumura K, Toba H, Yoshida M, Takizawa H, Tangoku A.. A randomized, open label study of the efficacy of prophylactic 24-h low-dose landiolol for atrial fibrillation in transthoracic esophagectomy. Esophagus 2017;14:97–103.

Horikoshi Y, Goyagi T, Kudo R, Kodama S, Horiguchi T, Nishikawa T.. The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia, and plasma IL-6 elevation in patients undergoing esophageal surgery: a randomized controlled clinical trial. J Clin Anesth 2017;38:111–116. PubMed

Ojima T, Nakamori M, Nakamura M, Katsuda M, Hayata K, Kato T, Kitadani J, Tabata H, Takeuchi A, Yamaue H.. Randomized clinical trial of landiolol hydrochloride for the prevention of atrial fibrillation and postoperative complications after oesophagectomy for cancer. Br J Surg 2017;104:1003–1009. PubMed

Yamakage M, Iwasaki S, Jeong SW, Satoh J, Namiki A.. Beta-1 selective adrenergic antagonist landiolol and esmolol can be safely used in patients with airway hyperreactivity. Heart Lung 2009;38:48–55. PubMed