Heart Rate Control with Landiolol Hydrochloride in Infants and Neonates During Cardiac Surgery

Area of Science:

• Pediatric Cardiology
• Cardiovascular Pharmacology
• Anesthesiology

Background:

• Perioperative tachyarrhythmias are common and increase mortality/morbidity in pediatric cardiac surgery.
• Ultrashort-acting beta-blockers like landiolol offer selective heart rate control.
• Limited data exists on landiolol's use in neonates and infants undergoing cardiac surgery.

Purpose of the Study:

• To assess the safety and efficacy of landiolol for heart rate control in pediatric patients under one year of age during cardiac surgery.
• To determine the proportion of patients achieving a target heart rate (HR < 160 bpm) by the end of surgery.

Main Methods:

• Retrospective review of 24 pediatric patients (<1 year) with intraoperative tachycardia during cardiac surgery treated with landiolol.
• Patients received landiolol hydrochloride (Rapibloc®) at a Pediatric Heart Center.
• Primary endpoint: proportion achieving target HR by surgery end; secondary: HR normalization time, hemodynamic stability, adverse events.

Main Results:

• 83% of patients achieved the target HR (<160 bpm) by surgery's end; 100% achieved it during treatment.
• Median HR normalization time was 4.0 minutes; 75% achieved it within 18.5 minutes.
• Landiolol maintained hemodynamic stability, with no increased vasopressor use. Favorable safety profile with no drug-related adverse events.

Conclusions:

• Landiolol is effective and safe for heart rate control in neonates and infants experiencing tachycardia during cardiac surgery.
• The drug facilitates rapid HR normalization while maintaining hemodynamic stability.
• Findings support landiolol's use in this vulnerable pediatric population.