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

Perioperative tachyarrhythmias are common in children undergoing cardiac surgery, contributing to significant mortality and morbidity. Landiolol, an ultrashort-acting beta-blocker, offers selective heart rate (HR) control in pediatric patients with tachycardia during cardiac surgery. The LANDI-cardioPed study assessed landiolol's safety and efficacy in children during cardiac surgery. The retrospective review included patients under 1 year of age with intraoperative tachycardia during cardiac surgery treated with landiolol hydrochloride (Rapibloc®) at the Pediatric Heart Center Giessen, Germany (June 2017-October 2022). The primary endpoint was the proportion of patients achieving a target HR (< 160 bpm) by surgery end. Among 24 patients (46% neonates, 54% infants; mean weight: 4.8 kg; preexisting heart failure in 71%), 83% achieved the target HR by surgery's end, with all patients reaching it during treatment. Median HR normalization time was 4.0 min and 75% of children reached it within 18.5 min. Landiolol demonstrated good hemodynamic stability. It reduced HR by 6% from baseline while maintaining stable blood pressure and HR/BP ratios, with no increased vasopressor use. The drug was titrated individually, with a mean initial dose of 23 µg/kg/min, the dose was 26 µg/kg/min upon reaching target HR, and the maximum dose of 49 µg/kg/min. The treatment duration averaged 10.5 h. Safety was favorable; three adverse events unrelated to landiolol were reported, and no dose interruptions occurred. Landiolol was effective and safe for HR control in neonates and infants with tachycardia during cardiac surgery, which aligns with current knowledge on its use in children.