Landiolol: A Review in Tachyarrhythmias

Intravenous landiolol [Rapibloc^® (EU)], an ultra short-acting highly cardioselective β₁-blocker, is approved in the EU for the rapid short-term control of tachyarrhythmias in the perioperative and intensive care settings. It has long been used in Japan to treat perioperative tachyarrhythmias. The efficacy of landiolol has been demonstrated in a large number of randomized controlled clinical trials. Landiolol significantly reduced heart rate in patients with postoperative or intraoperative supraventricular tachycardia relative to placebo and in those with atrial fibrillation/flutter and left ventricular dysfunction relative to digoxin. It was more effective than diltiazem in converting postoperative atrial fibrillation (POAF) to normal sinus rhythm. Perioperative prophylactic administration of landiolol significantly reduced the incidence of POAF during the first week after cardiac and other surgeries, compared with diltiazem, placebo or no landiolol treatment. Landiolol also attenuated adverse haemodynamic and other responses to invasive procedures such as percutaneous coronary intervention, tracheal intubation, extubation and electroconvulsive therapy. Landiolol was generally well tolerated, with a relatively low risk of hypotension and bradycardia. Landiolol has more favourable pharmacological properties than esmolol, a short-acting β-blocker commonly used for the rapid control of heart rate. Although additional comparative studies are warranted to define the place of landiolol relative to esmolol, current evidence suggest that landiolol is a useful option for the rapid short-term control of tachyarrhythmias. Landiolol offers a simple dosage scheme and is available in two easy-to-use formulations (concentrate and powder).