Landiolol for rate control in decompensated heart failure due to atrial fibrillation: the LARISA trial

Rate control of atrial fibrillation (AF) in acute heart failure (AHF) with reduced left ventricular ejection fraction (LVEF) is challenging. We evaluated the safety and efficacy of intensive rate control (IRC) using landiolol with adjunctive digoxin.

Forty patients with AHF due to AF [heart rate (HR) > 130/min, LVEF <40%] were randomized to IRC with landiolol plus digoxin or standard rate control therapy. The primary endpoint was sustained HR reduction >20% or <115/min at 2 h. Haemodynamics, dyspnoea, and lung congestion were assessed serially. HR control was achieved faster in the IRC vs. standard group (median 1.5 vs. 4 h; P = 0.016). At 2 h, HR decreased by 40% of the IRC group vs. 23% of standard therapy group (P = 0.045), and the primary endpoint was reached in 80% vs. 20% of the patients, respectively (P = 0.04). IRC resulted in greater dyspnoea relief and lung decongestion without excess hypotension or adverse events. At 24 h, outcomes between the groups were similar.

In AHF with reduced LVEF, protocolized landiolol-based intensive rate control provides faster and safe HR reduction with early symptomatic benefit compared with standard therapy. Pre-registered Clinical Trial Number:  ClinicalTrials.org: NCT04694092.