Abstract 10145: Impacts of Patient Characteristics on the Efficacy of Landiolol in Patients With Atrial Fibrillation/Flutter and Left Ventricular Dysfunction: Sub-analysis of the J-land Study
Aims: The sub-analysis for the patient characteristics was to evaluate the impact on the efficacy of landiolol in patients with atrial fibrillation/flutter(AF/AFL) and left ventricular (LV) dysfunction.
Methods and Results: A rapid heart rate (HR) during AF/AFL in LV dysfunction often impairs cardiac performance. The J-Land study was conducted to compare the efficacy and safety of landiolol, an ultra-short-acting β-blocker, with those of digoxin for swift control of tachycardia in AF/AFL in patients with LV dysfunction. The 200 patients with AF/AFL, HR ≥120 beats/min, and LV ejection fraction 25-50% were randomized to receive either landiolol (n=93) or digoxin(n=107). Successful HR control was defined as ≥20% reduction in HR together with HR <110 beats/min at 2 hours after starting intravenous administration of landiolol or digoxin. The mean HR at baseline was 138.2±15.7 and 138.0±15.0 beats/min in the landiolol and digoxin groups, respectively. Successful HR control was achieved in 48.0% of patients treated with landiolol and in 13.9% of patients treated with digoxin (P<0.0001). The efficacy in patients with NYHA class III was 52.3% in Landiolol, 13.8% in Digoxin (P<0.001), and the efficacy in patients with NYHA class IV was 35.3% and 9.1% in each group, respectively (P=0.172). The efficacy in patients with HR < 140 bpm was 60.0% and 18.5% in each group (P<0.001), and the efficacy in patients with HR ≥ 140 bpm was 25.9% and 6.8% in each group, respectively (P=0.034). The efficacy in patients with SBP < 120 mmHg was 45.7% and 14.0% in each group (P=0.001), and the efficacy in patients with SBP ≥ 120 bpm was 51.1% and 12.7% in each group, respectively (P<0.001). The efficacy in patients with LVEF 25-35% was 45.7% and 14.0% in each group (P<0.001), and the efficacy in patients with LVEF 35-50% was 51.1% and 12.7% in each group, respectively(P<0.001). Serious adverse events were reported in 2 and 3 patients in each group, respectively.
Conclusions: Landiolol was more effective for controlling rapid HR than digoxin in AF/AFL patients with LV dysfunction, and could be considered as a therapeutic option in this clinical setting. Furthermore, regardless of NYHA, HR, SBP, and LVEF, as compared with digoxin, the effectiveness of landiolol was mostly better.
- © 2013 by American Heart Association, Inc.