Introduction: Landiolol is a highly β1-selective, ultra-short-acting beta-blocker. This study aimed to analyze the cardiovascular effects and safety profile of landiolol in ICU patients.
Methods: This retrospective, observational study included patients admitted to medical or surgical ICUs in our university hospital who received landiolol. Cardiovascular parameters, including heart rate (HR), systolic, diastolic, and mean blood pressure, vasopressor catecholamine doses, and blood lactate levels, were extracted at baseline, H1, H2, H6, and H24. The primary endpoint was a composite safety outcome, defined as a decrease in mean arterial pressure (MAP) below 64 mmHg, bradycardia (HR < 50 bpm), or an increase in vasopressor catecholamine dose of more than 50%.
Results: Between January 2021 and February 2023, 144 patients treated with landiolol were identified, with a median age of 67 years; 70.1% were male. The mean norepinephrine dose at landiolol initiation was 0.31 µg/kg/min [95% CI: 0.20-0.43]. The primary indications for landiolol treatment were atrial fibrillation (86.8%), sinus tachycardia associated with septic shock (5.5%), atrial flutter (4.2%), sinus tachycardia without shock (1.4%), sinus sinus tachycardia with postoperative vasoplegic shock (0.7%), atrial tachycardia (0.7%) and junctional tachycardia (0.7%). The median duration of landiolol treatment was 1.2 days [0.5–3.2], with a mean landiolol dose of 6.76 µg/kg/min [95% CI: 6.26-7.26] over the first 24 hours. The primary safety endpoint was met in 7.8%, 11%, 14.3%, and 11% of patients at H1, H2, H6, and H24, respectively. HR decreased from 157 bpm at baseline to 111 bpm at H6 (p < 0.0001) and 103 bpm at H24 (p < 0.0001). MAP and vasopressor doses remained stable over time. HR below 110 bpm was achieved in 52.8% of patients at H6 and in 63.2% of patients at H24. Conversion to sinus rhythm at H24 was observed in 61 of 133 patients (46%) initially in atrial fibrillation. ICU mortality was 34%.
Conclusions: In our experience, landiolol appears to be a safe option for treating supraventricular tachyarrhythmia in ICU patients. Careful dose titration to target HR, as recommended by atrial fibrillation guidelines, can be achieved with relatively low doses of landiolol, with minimal impact on blood pressure and stable vasopressor requirements over time.
