692 results on '"Landiolol"'
Search Results
2. The Impact of Chronic Oral Beta-Blocker Intake on Intravenous Bolus Landiolol Response in Hospitalized Intensive Care Patients with Sudden-Onset Supraventricular Tachycardia—A Post Hoc Analysis of a Cross-Sectional Trial.
- Author
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Eibensteiner, Felix, Mosor, Emmilie, Tihanyi, Daniel, Anders, Sonja, Kornfehl, Andrea, Neymayer, Marco, Oppenauer, Julia, Veigl, Christoph, Al Jalali, Valentin, Domanovits, Hans, Sulzgruber, Patrick, and Schnaubelt, Sebastian
- Subjects
- *
DEGLUTITION , *INTENSIVE care patients , *SUPRAVENTRICULAR tachycardia , *HEART beat , *BLOOD pressure , *CROSS-sectional method - Abstract
Background: Landiolol, a highly cardioselective agent with a short half-life (2.4–4 min), is commonly used as a perfusor or bolus application to treat tachycardic arrhythmia. Some small studies suggest that prior oral β-blocker use results in a less effective response to intravenous β-blockers. Methods: This study investigated whether prior chronic oral β-blocker (Lβ) or no prior chronic oral β-blocker (L–) intake influences the response to intravenous push-dose Landiolol in intensive care patients with acute tachycardic arrhythmia. Results: The effects in 30 patients (67 [55–72] years) were analyzed, 10 (33.3%) with and 20 (66.7%) without prior oral β-blocker therapy. Arrhythmias were diagnosed as tachycardic atrial fibrillation in 14 patients and regular, non-fluid-dependent, supraventricular tachycardia in 16 cases. Successful heart rate control (Lβ 4 vs. L– 7, p = 1.00) and rhythm control (Lβ 3 vs. L– 6, p = 1.00) did not significantly differ between the two groups. Both groups showed a significant decrease in heart rate when comparing before and after the bolus administration, without significant differences between the two groups (Lβ −26/min vs. L– −33/min, p = 0.528). Oral β-blocker therapy also did not influence the change in mean arterial blood pressure after Landiolol bolus administration (Lβ −5 mmHg vs. L– −4 mmHg, p = 0.761). Conclusions: A prior chronic intake of β-blockers neither affected the effectiveness of push-dose Landiolol in heart rate or rhythm control nor impacted the difference in heart rate or mean arterial blood pressure before and after the Landiolol boli. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
3. Landiolol for Treatment of New-Onset Atrial Fibrillation in Critical Care: A Systematic Review.
- Author
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Levy, Bruno, Slama, Michel, Lakbar, Ines, Maizel, Julien, Kato, Hiromi, Leone, Marc, and Okada, Motoi
- Subjects
- *
ATRIAL fibrillation , *CRITICAL care medicine , *HEART beat , *MEDICAL care , *CARDIAC surgery - Abstract
Background: new-onset atrial fibrillation remains a common complication in critical care settings, often necessitating treatment when the correction of triggers is insufficient to restore hemodynamics. The treatment strategy includes electric cardioversion in cases of hemodynamic instability and either rhythm control or rate control in the absence of instability. Landiolol, an ultrashort beta-blocker, effectively controls heart rate with the potential to regulate rhythm. Objectives This review aims to compare the efficacy of landiolol in controlling heart rate and converting to sinus rhythm in the critical care setting. Methods: We conducted a comprehensive review of the published literature from 2000 to 2022 describing the use of landiolol to treat atrial fibrillation in critical care settings, excluding both cardiac surgery and medical cardiac care settings. The primary outcome assessed was sinus conversion following landiolol treatment. Results: Our analysis identified 17 publications detailing the use of landiolol for the treatment of 324 critical care patients. While the quality of the data was generally low, primarily comprising non-comparative studies, landiolol consistently demonstrated similar efficacy in controlling heart rate and facilitating conversion to sinus rhythm in both non-surgical (75.7%) and surgical (70.1%) settings. The incidence of hypotension associated with landiolol use was 13%. Conclusions: The use of landiolol in critical care patients with new-onset atrial fibrillation exhibited comparable efficacy and tolerance in both non-surgical and surgical settings. Despite these promising results, further validation through randomized controlled trials is necessary. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
4. An Overview of the Pharmacokinetics and Pharmacodynamics of Landiolol (an Ultra-Short Acting β1 Selective Antagonist) in Atrial Fibrillation.
- Author
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Floria, Mariana, Oancea, Alexandru Florinel, Morariu, Paula Cristina, Burlacu, Alexandru, Iov, Diana Elena, Chiriac, Cristina Petronela, Baroi, Genoveva Livia, Stafie, Celina Silvia, Cuciureanu, Magdalena, Scripcariu, Viorel, and Tanase, Daniela Maria
- Subjects
- *
ATRIAL fibrillation , *HEART beat , *PHARMACOKINETICS , *PHARMACODYNAMICS , *CHILD patients , *ARRHYTHMIA - Abstract
Landiolol is an ultra-short-acting, selective β1-adrenergic receptor blocker that was originally approved in Japan for the treatment of intraoperative tachyarrhythmias. It has gained attention for its use in the management of tachyarrhythmias and perioperative tachycardia, especially atrial fibrillation for both cardiac and non-cardiac surgeries. It can be the ideal agent for heart rate control due to its high β1-selectivity, potent negative chronotropic effect, a limited negative inotropic potential, and an ultrashort elimination half-life (around 4 min); moreover, it may have a potential therapeutic effects for sepsis and pediatric patients. Landiolol seems to be superior to other short-acting and selective beta-blockers such as esmolol. This review aims to provide a comprehensive overview of landiolol, a new ultra-short-acting β1 selective antagonist, including its pharmacology, clinical applications, efficacy, safety profile, and future directions in research and clinical data. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Beta-Blockers for Shelter From the Storm.
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Wang, Tim T. and Alston, Theodore A.
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ADRENERGIC beta blockers , *THYROID crisis , *THYROID hormone receptors , *HORMONE antagonists , *BETA adrenoceptors , *STRUCTURE-activity relationships - Abstract
This document is an editorial from the journal Critical Care Medicine. It discusses the use of beta-blockers as a potential treatment for thyroid storm, a severe and life-threatening condition caused by excessive thyroid hormone levels. The authors emphasize the importance of rigorously examining the strengths and limitations of machine learning-derived predictive models in healthcare decision-making. They also highlight the ethical challenges faced by clinicians that cannot be solved by machine learning alone. The authors disclose their affiliations and potential conflicts of interest. The document includes references to previous studies on thyroid storm and related topics. [Extracted from the article]
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- 2024
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6. Prevention of Atrial Fibrillation by Low-dose Landiolol Administration After Cardiac Surgery (LANDIPROTEC)
- Published
- 2023
7. Intravenous Landiolol for Rate Control in Supraventricular Tachyarrhythmias in Patients with Left Ventricular Dysfunction: A Systematic Review and Meta-Analysis.
- Author
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Nasoufidou, Athina, Papazoglou, Andreas S., Stachteas, Panagiotis, Karagiannidis, Efstratios, Samaras, Athanasios, Alexiou, Sophia, Mourtzos, Michail-Angelos, Kassimis, George, and Fragakis, Nikolaos
- Subjects
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LEFT ventricular dysfunction , *TACHYARRHYTHMIAS , *HEART beat , *VENTRICULAR dysfunction , *ATRIAL flutter - Abstract
Background: This systematic review explores the effects of landiolol administration in individuals presenting with supraventricular tachyarrhythmia (SVT) and concurrent left ventricular dysfunction, without being septic or in a peri-operative period. Methods: We systematically searched PubMed, Cochrane, Web of Science, and Scopus databases, retrieving a total of 15 eligible studies according to prespecified eligibility criteria. Results: Patients treated with landiolol experienced a substantial reduction in heart rate (HR) (mean HR reduction: 42 bpm, 95% confidence intervals (CIs): 37–47, I2 = 82%) and were more likely to achieve the target HR compared to those receiving alternative antiarrhythmic therapy (pooled odds ratio (OR): 5.37, 95% CIs: 2.87–10.05, I2 = 0%). Adverse events, primarily hypotension, occurred in 14.7% of patients receiving landiolol, but no significant difference was observed between the landiolol and alternative antiarrhythmic receiving groups (pooled OR: 1.02, 95% CI: 0.57–1.83, I2 = 0%). No significant difference was observed between the two groups concerning sinus rhythm restoration (pooled OR: 0.97, 95% CI: 0.25–3.78, I2 = 0%) and drug discontinuation due to adverse events (pooled OR: 5.09, 95% CI: 0.6–43.38, I2 = 0%). Conclusion: While further research is warranted, this systematic review highlights the potential benefits of landiolol administration in the management of SVTs in the context of left ventricular dysfunction. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
8. Beta-blockade With Landiolol in Out-of-hospital Cardiac Arrest (Beta-Arrest)
- Author
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Michael Holzer, Principal Investigator, Professor of Emergency Medicine
- Published
- 2023
9. Comparison of Landiolol Versus Standard of Care for Prevention of Mortality in Patients Hospitalized for a Septic Shock With Hypercontractility (HyperBetashock)
- Author
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CH Dieppe, CH Elbeuf, CH Le Havre, Centre Hospitalier de Beauvais, CH Compiègne, CH Laon, University Hospital, Caen, CH Cherbourg, University Hospital, Lille, CH Douai, CH Montreuil, Centre Hospitalier de Roubaix, Centre Hospitalier de Bethune, CH Lomme, Centre Hospitalier de Lens, Tourcoing Hospital, Centre Hospitalier VALENCIENNES, Centre Hospitalier Arras, Hospital Ambroise Paré Paris, University Hospital, Brest, Henri Mondor University Hospital, Hospital Avicenne, University Hospital, Montpellier, CH Calais, Hôpital Edouard Herriot, Centre Hospitalier Universitaire de Nīmes, and Groupe Hospitalier Pitié-Salpêtrière
- Published
- 2023
10. Mechanisms of landiolol-mediated positive inotropy in critical care settings.
- Author
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Chalkias, Athanasios and O'Donnell, E. Paul
- Subjects
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CRITICALLY ill , *CARDIAC contraction , *PATIENTS , *ADRENERGIC beta blockers , *TREATMENT effectiveness , *SEPSIS , *HEALTH literacy , *CARDIOVASCULAR system , *HEART beat , *CRITICAL care medicine , *HEMODYNAMICS , *HEART failure , *CARDIOTONIC agents , *PHARMACODYNAMICS - Abstract
Purpose: To present the potential mechanisms by which landiolol enhances a positive inotropic response in critically ill patients. Methods: Analysis of preclinical, animal, and clinical data to provide novel knowledge and translate research findings into potential clinical application. Results: The super-selective β1-antagonist landiolol may increase inotropy and may be associated with positive outcomes in critically ill patients with acute decompensated heart failure or sepsis. Conclusion: This review sheds light on the potential mechanisms by which landiolol enhances a positive inotropic response, potentially alleviating the long-held concern over possible negative hemodynamic effects in critically ill patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
11. Landiolol for the prevention of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis.
- Author
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Cafaro, Teresa, Allwood, Melissa, McIntyre, William F., Park, Lily J., Daza, Julian, Ofori, Sandra N., Ke Wang, Michael, Borges, Flavia K., Conen, David, Marcucci, Maura, Healey, Jeff S., Whitlock, Richard P., Lamy, Andre, Belley-Côté, Emilie P., Spence, Jessica D., McGillion, Michael, and Devereaux, P. J.
- Abstract
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- Published
- 2023
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- View/download PDF
12. Optimal use of intravenous landiolol in acute cardiac care.
- Author
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Bezati, Sofia, Boultadakis, Antonios, Ventoulis, Ioannis, Polyzogopoulou, Eftihia, and Parissis, John T.
- Subjects
VENTRICULAR tachycardia ,HEART diseases ,MYOCARDIAL infarction ,CARDIAC patients ,MEDICAL research ,CARDIAC intensive care - Abstract
B-blockers are regarded as beneficial pharmacologic agents in cardiac care, but their role in the acute setting remains ambiguous. Increasing evidence supports the important role of landiolol in critical care, a highly cardioselective intravenous b-blocker with rapid onset of action and short elimination time. Among its most valuable properties, which may aid to overcome special reservations related to b-blocker therapy in the acute setting, landiolol has a potent negative chronotropic effect while at the same time it exhibits a mild negative inotropic effect. This expert opinion review aims to present basic pharmacologic aspects of landiolol and provide current clinical research focused on its efficacy and safety. Landiolol is a valuable and safe pharmacologic agent in acute cardiac care. Japanese and European guidelines have incorporated its use for the management of atrial tachyarrhythmia in patients with cardiac dysfunction. Although emerging clinical trials have experimented its use in patients with sustained ventricular tachycardia/fibrillation, acute myocardial infarction undergoing primary percutaneous intervention and in patients with septic cardiomyopathy, more studies are needed in order to establish its value in such cardiac conditions. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
13. The Impact of Chronic Oral Beta-Blocker Intake on Intravenous Bolus Landiolol Response in Hospitalized Intensive Care Patients with Sudden-Onset Supraventricular Tachycardia—A Post Hoc Analysis of a Cross-Sectional Trial
- Author
-
Felix Eibensteiner, Emmilie Mosor, Daniel Tihanyi, Sonja Anders, Andrea Kornfehl, Marco Neymayer, Julia Oppenauer, Christoph Veigl, Valentin Al Jalali, Hans Domanovits, Patrick Sulzgruber, and Sebastian Schnaubelt
- Subjects
intensive care medicine ,critical care ,cardioselective β-blockers ,landiolol ,arrhythmia ,dysrhythmia ,Pharmacy and materia medica ,RS1-441 - Abstract
Background: Landiolol, a highly cardioselective agent with a short half-life (2.4–4 min), is commonly used as a perfusor or bolus application to treat tachycardic arrhythmia. Some small studies suggest that prior oral β-blocker use results in a less effective response to intravenous β-blockers. Methods: This study investigated whether prior chronic oral β-blocker (Lβ) or no prior chronic oral β-blocker (L–) intake influences the response to intravenous push-dose Landiolol in intensive care patients with acute tachycardic arrhythmia. Results: The effects in 30 patients (67 [55–72] years) were analyzed, 10 (33.3%) with and 20 (66.7%) without prior oral β-blocker therapy. Arrhythmias were diagnosed as tachycardic atrial fibrillation in 14 patients and regular, non-fluid-dependent, supraventricular tachycardia in 16 cases. Successful heart rate control (Lβ 4 vs. L– 7, p = 1.00) and rhythm control (Lβ 3 vs. L– 6, p = 1.00) did not significantly differ between the two groups. Both groups showed a significant decrease in heart rate when comparing before and after the bolus administration, without significant differences between the two groups (Lβ −26/min vs. L– −33/min, p = 0.528). Oral β-blocker therapy also did not influence the change in mean arterial blood pressure after Landiolol bolus administration (Lβ −5 mmHg vs. L– −4 mmHg, p = 0.761). Conclusions: A prior chronic intake of β-blockers neither affected the effectiveness of push-dose Landiolol in heart rate or rhythm control nor impacted the difference in heart rate or mean arterial blood pressure before and after the Landiolol boli.
- Published
- 2024
- Full Text
- View/download PDF
14. Landiolol for Treatment of New-Onset Atrial Fibrillation in Critical Care: A Systematic Review
- Author
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Bruno Levy, Michel Slama, Ines Lakbar, Julien Maizel, Hiromi Kato, Marc Leone, and Motoi Okada
- Subjects
new-onset atrial fibrillation ,supraventricular tachycardia ,postoperative atrial fibrillation ,beta-blockers ,landiolol ,critical care setting ,Medicine - Abstract
Background: new-onset atrial fibrillation remains a common complication in critical care settings, often necessitating treatment when the correction of triggers is insufficient to restore hemodynamics. The treatment strategy includes electric cardioversion in cases of hemodynamic instability and either rhythm control or rate control in the absence of instability. Landiolol, an ultrashort beta-blocker, effectively controls heart rate with the potential to regulate rhythm. Objectives This review aims to compare the efficacy of landiolol in controlling heart rate and converting to sinus rhythm in the critical care setting. Methods: We conducted a comprehensive review of the published literature from 2000 to 2022 describing the use of landiolol to treat atrial fibrillation in critical care settings, excluding both cardiac surgery and medical cardiac care settings. The primary outcome assessed was sinus conversion following landiolol treatment. Results: Our analysis identified 17 publications detailing the use of landiolol for the treatment of 324 critical care patients. While the quality of the data was generally low, primarily comprising non-comparative studies, landiolol consistently demonstrated similar efficacy in controlling heart rate and facilitating conversion to sinus rhythm in both non-surgical (75.7%) and surgical (70.1%) settings. The incidence of hypotension associated with landiolol use was 13%. Conclusions: The use of landiolol in critical care patients with new-onset atrial fibrillation exhibited comparable efficacy and tolerance in both non-surgical and surgical settings. Despite these promising results, further validation through randomized controlled trials is necessary.
- Published
- 2024
- Full Text
- View/download PDF
15. An Overview of the Pharmacokinetics and Pharmacodynamics of Landiolol (an Ultra-Short Acting β1 Selective Antagonist) in Atrial Fibrillation
- Author
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Mariana Floria, Alexandru Florinel Oancea, Paula Cristina Morariu, Alexandru Burlacu, Diana Elena Iov, Cristina Petronela Chiriac, Genoveva Livia Baroi, Celina Silvia Stafie, Magdalena Cuciureanu, Viorel Scripcariu, and Daniela Maria Tanase
- Subjects
landiolol ,atrial fibrillation ,beta-blockers ,perioperative tachyarrhythmias ,cardiac surgery ,arrhythmias ,Pharmacy and materia medica ,RS1-441 - Abstract
Landiolol is an ultra-short-acting, selective β1-adrenergic receptor blocker that was originally approved in Japan for the treatment of intraoperative tachyarrhythmias. It has gained attention for its use in the management of tachyarrhythmias and perioperative tachycardia, especially atrial fibrillation for both cardiac and non-cardiac surgeries. It can be the ideal agent for heart rate control due to its high β1-selectivity, potent negative chronotropic effect, a limited negative inotropic potential, and an ultrashort elimination half-life (around 4 min); moreover, it may have a potential therapeutic effects for sepsis and pediatric patients. Landiolol seems to be superior to other short-acting and selective beta-blockers such as esmolol. This review aims to provide a comprehensive overview of landiolol, a new ultra-short-acting β1 selective antagonist, including its pharmacology, clinical applications, efficacy, safety profile, and future directions in research and clinical data.
- Published
- 2024
- Full Text
- View/download PDF
16. Landiolol for Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery (LANDI-POAF)
- Author
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Andreas Binder, Prinicipal Investigator
- Published
- 2021
17. Intravenous Landiolol for Rate Control in Supraventricular Tachyarrhythmias in Patients with Left Ventricular Dysfunction: A Systematic Review and Meta-Analysis
- Author
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Athina Nasoufidou, Andreas S. Papazoglou, Panagiotis Stachteas, Efstratios Karagiannidis, Athanasios Samaras, Sophia Alexiou, Michail-Angelos Mourtzos, George Kassimis, and Nikolaos Fragakis
- Subjects
landiolol ,heart failure ,atrial fibrillation ,atrial flutter ,arrhythmia ,tachycardia ,Medicine - Abstract
Background: This systematic review explores the effects of landiolol administration in individuals presenting with supraventricular tachyarrhythmia (SVT) and concurrent left ventricular dysfunction, without being septic or in a peri-operative period. Methods: We systematically searched PubMed, Cochrane, Web of Science, and Scopus databases, retrieving a total of 15 eligible studies according to prespecified eligibility criteria. Results: Patients treated with landiolol experienced a substantial reduction in heart rate (HR) (mean HR reduction: 42 bpm, 95% confidence intervals (CIs): 37–47, I2 = 82%) and were more likely to achieve the target HR compared to those receiving alternative antiarrhythmic therapy (pooled odds ratio (OR): 5.37, 95% CIs: 2.87–10.05, I2 = 0%). Adverse events, primarily hypotension, occurred in 14.7% of patients receiving landiolol, but no significant difference was observed between the landiolol and alternative antiarrhythmic receiving groups (pooled OR: 1.02, 95% CI: 0.57–1.83, I2 = 0%). No significant difference was observed between the two groups concerning sinus rhythm restoration (pooled OR: 0.97, 95% CI: 0.25–3.78, I2 = 0%) and drug discontinuation due to adverse events (pooled OR: 5.09, 95% CI: 0.6–43.38, I2 = 0%). Conclusion: While further research is warranted, this systematic review highlights the potential benefits of landiolol administration in the management of SVTs in the context of left ventricular dysfunction.
- Published
- 2024
- Full Text
- View/download PDF
18. Landiolol for the prevention of postoperative atrial fibrillation: a trial sequential analysis
- Author
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Chen, I-Wen, Kao, Chia-Li, and Hung, Kuo-Chuan
- Published
- 2024
- Full Text
- View/download PDF
19. Landiolol for Rate Control in Decompensated Heart Failure Due to Atrial Fibrillation (LARISA)
- Author
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Marek Sramko, Head of the Department of Acute Cardiology
- Published
- 2021
20. Hemodynamic and Rhythmologic Effects of Push-Dose Landiolol in Critical Care—A Retrospective Cross-Sectional Study.
- Author
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Schnaubelt, Sebastian, Eibensteiner, Felix, Oppenauer, Julia, Tihanyi, Daniel, Neymayer, Marco, Brock, Roman, Kornfehl, Andrea, Veigl, Christoph, Al Jalali, Valentin, Anders, Sonja, Steinlechner, Barbara, Domanovits, Hans, and Sulzgruber, Patrick
- Subjects
- *
HEMODYNAMICS , *BLOOD pressure , *CRITICAL care medicine , *HEART beat , *ARRHYTHMIA , *CROSS-sectional method , *VENTILATION , *SUPRAVENTRICULAR tachycardia - Abstract
Background: The highly β1-selective beta-blocker Landiolol is known to facilitate efficient and safe rate control in non-compensatory tachycardia or dysrhythmia when administered continuously. However, efficacy and safety data of the also-available bolus formulation in critically ill patients are scarce. Methods: We conducted a retrospective cross-sectional study on a real-life cohort of critical care patients, who had been treated with push-dose Landiolol due to sudden-onset non-compensatory supraventricular tachycardia. Continuous hemodynamic data had been acquired via invasive blood pressure monitoring. Results: Thirty patients and 49 bolus applications were analyzed. Successful heart rate control was accomplished in 20 (41%) cases, rhythm control was achieved in 13 (27%) episodes, and 16 (33%) applications showed no effect. Overall, the heart rate was significantly lower (145 (130–150) vs. 105 (100–125) bpm, p < 0.001) in a 90 min post-application observational period in all subgroups. The median changes in blood pressure after the bolus application did not reach clinical significance. Compared with the ventilation settings before the bolus application, the respiratory settings including the required FiO2 after the bolus application did not differ significantly. No serious adverse events were seen. Conclusions: Push-dose Landiolol was safe and effective in critically ill ICU patients. No clinically relevant impact on blood pressure was noted. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
21. Landiolol in Septic Shock — No One-Size-Fits-All Approach.
- Author
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Schnaubelt, Sebastian, Eibensteiner, Felix, and Sulzgruber, Patrick
- Subjects
- *
SEPTIC shock , *CRITICAL care medicine - Published
- 2024
- Full Text
- View/download PDF
22. Comparison of Two Strategies for the Management of Atrial Fibrillation After Cardiac Surgery (FAAC)
- Published
- 2020
23. Landiolol in Postoperative Atrial Fibrillation (MMELPOAF)
- Published
- 2019
24. Prognostic Impact of Landiolol in Patients with Acute Heart Failure and Atrial Fibrillation with Rapid Ventricular Rates: A Pilot Observational Study.
- Author
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Shirotani, Shota, Jujo, Kentaro, Abe, Takuro, Kametani, Motoko, Minami, Yuichiro, Suzuki, Atsushi, Shiga, Tsuyoshi, and Hagiwara, Nobuhisa
- Subjects
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VENTRICULAR fibrillation , *ATRIAL fibrillation , *HEART failure patients , *CARDIAC output , *SCIENTIFIC observation - Abstract
Introduction: Guidelines recommend ventricular rate control to <130 bpm during atrial fibrillation (AF) in patients with acute decompensated heart failure (ADHF) to avoid aggravating deteriorations in cardiac outputs. We aimed to evaluate the prognostic impact of landiolol in patients with ADHF and AF. Methods: This observational study included 60 patients who were urgently hospitalized with ADHF and presented with AF and a heart rate (HR) ≥130 bpm at admission. The patients were assigned to the landiolol group (n = 37) or the reference group (n = 23) based on their intravenous landiolol use within 24 h after admission. The primary endpoint was death from any cause. Results: The groups' baseline characteristics were similar. A significant HR reduction occurred in the landiolol group at 2 h after admission. Compared with the reference group, the HR was significantly lower (111.6 vs. 97.9 bpm, p = 0.02) and the absolute HR reduction was greater (−32.2 vs. −50.0 bpm, p = 0.006) in the landiolol group at 48 h after admission. The landiolol group's mortality rate was significantly lower than that in the reference group (log-rank test, p = 0.032). landiolol use within 24 h after admission was independently associated with lower all-cause mortality (adjusted hazard ratio: 0.15, 95% confidence interval: 0.02–0.92). Conclusion: Patients with ADHF and AF who received landiolol for rate control during the acute phase had better prognoses than those who did not receive landiolol. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
25. Effect of landiolol in patients with tachyarrhythmias and acute decompensated heart failure (ADHF): a case series
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Valentina Ditali, Laura Garatti, Nuccia Morici, Luca Villanova, Claudia Colombo, Fabrizio Oliva, and Alice Sacco
- Subjects
Acute decompensated heart failure ,Inotropes ,Landiolol ,Tachycardia ,Tachyarrhythmias ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Tachycardia and rapid tachyarrhythmias are common in acute clinical settings and may hasten the deterioration of haemodynamics in patients with acute decompensated heart failure (ADHF), treated with inotropes. The concomitant use of a short‐acting β1‐selective beta‐blocker, such as landiolol, could rapidly and safely restore an adequate heart rate without any negative inotropic effect. We present a case series of five patients with left ventricular dysfunction, admitted to our Intensive Cardiac Care Unit with ADHF deteriorated to cardiogenic shock, treated with a combination of landiolol and inotropes. Landiolol was effective in terms of rate control and haemodynamics optimization, enabling de‐escalation of catecholamine dosing in all patients. The infusion was always well tolerated without hypotension. In conclusion, a continuous infusion of a low dose of landiolol (3–16 mcg/kg/min) to manage tachycardia and ventricular or supraventricular tachyarrhythmias in haemodynamically unstable patients may be considered.
- Published
- 2022
- Full Text
- View/download PDF
26. Effects of Landiolol on Macrocirculatory Parameters and Left and Right Ventricular Performances Following Cardiac Surgery: A Randomized Controlled Trial.
- Author
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Ferraris, Arnaud, Jacquet-Lagrèze, Matthias, Cazenave, Laure, Fornier, William, Jalalzai, Wajma, Rousseau-Saine, Nicolas, Pozzi, Matteo, and Fellahi, Jean-Luc
- Abstract
Postoperative atrial fibrillation (POAF) is a major complication after cardiac surgery, and an early postoperative introduction of beta-blockers is recommended to reduce its incidence. Landiolol, a new intravenous short-acting beta-1 blocker, could present a useful and safe macrohemodynamic profile after cardiac surgery. Detailed metabolic and hemodynamic effects of landiolol on cardiac performance, however, remain poorly documented. The authors aimed to investigate the dose-dependent hemodynamic and metabolic effects of landiolol in that specific setting. A prospective, randomized, double-blind study versus placebo. A tertiary university hospital. Adult patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Incremental doses of intravenous landiolol (0.5, 1, 2, 5, and 10 μg/kg/min) were given within the 2 hours after arrival in the intensive care unit. Macrocirculatory parameters and cardiac performances were derived from transpulmonary thermodilution and transthoracic echocardiography. Metabolic data were obtained from arterial blood tests. From January to November 2019, 58 patients were analyzed and divided into a landiolol group (n = 30) and a control group (n = 28). Heart rate significantly decreased in the landiolol group (p < 0. 01), whereas mean arterial pressure and stroke volume remained unchanged. No significant modification was found in both left and right systolic and diastolic performances. Metabolic variables were similar in both groups. New-onset POAF occurred in 9 (32%) versus 5 (17%) patients in the control and landiolol groups, respectively (p = 0. 28). Infusion of landiolol in the range of 0.5-to-10 μg/kg/min during the early postoperative period presents a good macrohemodynamic safety profile in cardiac surgical patients and could be useful to prevent POAF. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
27. Mortality in septic patients treated with esmolol or landiolol: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.
- Author
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Sato R, Messina S, Hasegawa D, Santonocito C, Scimonello G, Sanfilippo G, Morelli A, Dugar S, and Sanfilippo F
- Abstract
Background: The latest meta-analysis indicated potential survival benefits from ultra-short-acting β-blockers in septic patients with persistent tachycardia. However, subsequent multicenter randomized controlled trials (RCTs) have reported conflicting findings, prompting the need for an updated meta-analysis to incorporate these newly published RCTs., Research Question: Does the use of ultra-short-acting β-blockers (esmolol or landiolol) in septic patients with persistent tachycardia improve mortality?, Study Design and Methods: We conducted an updated systematic search till April 2
nd , 2024 exploring MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for RCTs reporting mortality in adult septic patients treated with esmolol or landiolol as compared to none or placebo, and published in English. Meta-analyses were conducted with the random effect model. The primary outcome was mortality at the longest follow-up, with subgroup analysis separating single from large multicenter RCTs., Results: Eight RCTs (885 patients) were included in the primary analysis. Ultra-short acting β-blockers did not significantly improve mortality at the longest follow-up (risk ratio [RR] 0.84; 95% confidence interval [CI], 0.68-1.02; p=0.08, I2 =51%, very low certainty of the evidence) and 28-day mortality (RR 0.77; 95%CI 0.59-1.00; p=0.05; I2 =62%). Subgroup analyses of mortality outcomes pointed towards different results between single-center and multicenter RCTs. Trial sequence analyses (TSAs) showed that both mortality outcomes were not robust. The sensitivity analyses suggested a significant reduction in mortality by adding RCTs published in non-English language., Interpretation: In this updated meta-analysis, the use of esmolol or landiolol did not reduce mortality in septic patients with persistent tachycardia. However, results were not robust and outcomes differed between single-center and multicenter RCTs. Moreover, sensitivity analyses showed the fragility of the primary outcome. Further studies regarding ultra-short-acting β-blockers with advanced cardiac monitoring or serial echocardiography are warranted., Clinical Trial Registration: The protocol was preventively registered in the PROSPERO database on the 31th January 2024 (Registration number: CRD: 42024503570)., (Copyright © 2024. Published by Elsevier Inc.)- Published
- 2024
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28. β1-blocker in sepsis
- Author
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Daisuke Hasegawa, Ryota Sato, and Osamu Nishida
- Subjects
Sepsis ,Ultrashort-acting β1-blockers ,Esmolol ,Landiolol ,Non-compensatory tachycardia ,Persistent tachycardia ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The use of ultrashort-acting β1-blockers recently has attracted attention in septic patients with non-compensatory tachycardia. We summarized the metabolic and hemodynamic effects and the clinical evidence of ultrashort-acting β1-blockers. Main body A recent meta-analysis showed that ultrashort-acting β1-blockers reduced the mortality in septic patients with persistent tachycardia. However, its mechanism to improve mortality is not fully understood yet. We often use lactate as a marker of oxygen delivery, but an impaired oxygen use rather than reduced oxygen delivery has been recently proposed as a more reasonable explanation of hyperlactatemia in patients with sepsis, leading to a question of whether β1-blockers affect metabolic systems. While the stimulation of the β2-receptor accelerates glycolysis and lactate production, the role of β1-blocker in lactate production remains unclear and studies investigating the role of β1-blockers in lactate kinetics are warranted. A meta-analysis also reported that ultrashort-acting β1-blockers increased stroke volume index, while it reduced heart rate, resulting in unchanged cardiac index, mean arterial pressure, and norepinephrine requirement at 24 h, leading to an improvement of cardiovascular efficiency. On the other hand, a recent study reported that heart rate reduction using fast esmolol titration in the very early phase of septic shock caused hemodynamic instability, suggesting that ultrashort-acting β1-blockers should be started only after completing initial resuscitation. While many clinicians still do not feel comfortable controlling sinus tachycardia, one randomized controlled trial in which the majority had sinus tachycardia suggested the mortality benefit of ultrashort-acting β1-blockers. Therefore, it still deems to be reasonable to control sinus tachycardia with ultrashort-acting β1-blockers after completing initial resuscitation. Conclusion Accumulating evidence is supporting the use of ultrashort-acting β1-blockers while larger randomized controlled trials to clarify the effect of ultrashort-acting β1-blockers are still warranted.
- Published
- 2021
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29. Hemodynamic and Rhythmologic Effects of Push-Dose Landiolol in Critical Care—A Retrospective Cross-Sectional Study
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Sebastian Schnaubelt, Felix Eibensteiner, Julia Oppenauer, Daniel Tihanyi, Marco Neymayer, Roman Brock, Andrea Kornfehl, Christoph Veigl, Valentin Al Jalali, Sonja Anders, Barbara Steinlechner, Hans Domanovits, and Patrick Sulzgruber
- Subjects
Landiolol ,beta-blockers ,critical care ,intensive care ,hemodynamic stability ,dysrhythmia ,Medicine ,Pharmacy and materia medica ,RS1-441 - Abstract
Background: The highly β1-selective beta-blocker Landiolol is known to facilitate efficient and safe rate control in non-compensatory tachycardia or dysrhythmia when administered continuously. However, efficacy and safety data of the also-available bolus formulation in critically ill patients are scarce. Methods: We conducted a retrospective cross-sectional study on a real-life cohort of critical care patients, who had been treated with push-dose Landiolol due to sudden-onset non-compensatory supraventricular tachycardia. Continuous hemodynamic data had been acquired via invasive blood pressure monitoring. Results: Thirty patients and 49 bolus applications were analyzed. Successful heart rate control was accomplished in 20 (41%) cases, rhythm control was achieved in 13 (27%) episodes, and 16 (33%) applications showed no effect. Overall, the heart rate was significantly lower (145 (130–150) vs. 105 (100–125) bpm, p < 0.001) in a 90 min post-application observational period in all subgroups. The median changes in blood pressure after the bolus application did not reach clinical significance. Compared with the ventilation settings before the bolus application, the respiratory settings including the required FiO2 after the bolus application did not differ significantly. No serious adverse events were seen. Conclusions: Push-dose Landiolol was safe and effective in critically ill ICU patients. No clinically relevant impact on blood pressure was noted.
- Published
- 2023
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30. Blood Pressure Recovery After Dobutamine Antagonism: Partial With Landiolol, None With Esmolol.
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Krumpl, Günther, Ulč, Ivan, Trebs, Michaela, Kadlecová, Pavla, Hodisch, Juri, and Husch, Bernhard
- Subjects
- *
DIASTOLIC blood pressure , *SYSTOLIC blood pressure , *DOBUTAMINE , *HEART beat , *ESMOLOL - Abstract
We investigated the hemodynamic effects of 2 short‐acting β1‐blockers, landiolol and esmolol, in the continuous presence of dobutamine in a prospective, single‐center, randomized, crossover study in 16 healthy White volunteers. Dobutamine was infused at a rate sufficient to increase the heart rate by at least 30 beats per minute, followed by a 60‐minute infusion of 50 μg/kg/min esmolol or 10 μg/kg/min landiolol on top of the unchanged dobutamine infusion. Concentrations of β‐blockers and their metabolites in blood, heart rate, and blood pressure were followed for 180 minutes. Landiolol reduced the dobutamine‐induced heart rate and blood pressure increases better than esmolol. After discontinuation of β‐blocker administration, heart rate recovered swiftly to preinfusion values in both study arms. Systolic and diastolic blood pressure recovered partially after landiolol but showed a continued reduction after esmolol. No serious adverse events were observed. The heart rate effect is characteristic for β‐blockers, whereas the blood pressure effects are likely due to direct and indirect β‐blocker effects as well as influences on various ion channels. This may explain why landiolol that is devoid of effects on renin and sodium, calcium, and potassium channels behaves different from esmolol with respect to blood pressure recovery. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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31. Effect of landiolol in patients with tachyarrhythmias and acute decompensated heart failure (ADHF): a case series.
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Ditali, Valentina, Garatti, Laura, Morici, Nuccia, Villanova, Luca, Colombo, Claudia, Oliva, Fabrizio, and Sacco, Alice
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TACHYARRHYTHMIAS ,HEART failure patients ,LEFT ventricular dysfunction - Abstract
Tachycardia and rapid tachyarrhythmias are common in acute clinical settings and may hasten the deterioration of haemodynamics in patients with acute decompensated heart failure (ADHF), treated with inotropes. The concomitant use of a short‐acting β1‐selective beta‐blocker, such as landiolol, could rapidly and safely restore an adequate heart rate without any negative inotropic effect. We present a case series of five patients with left ventricular dysfunction, admitted to our Intensive Cardiac Care Unit with ADHF deteriorated to cardiogenic shock, treated with a combination of landiolol and inotropes. Landiolol was effective in terms of rate control and haemodynamics optimization, enabling de‐escalation of catecholamine dosing in all patients. The infusion was always well tolerated without hypotension. In conclusion, a continuous infusion of a low dose of landiolol (3–16 mcg/kg/min) to manage tachycardia and ventricular or supraventricular tachyarrhythmias in haemodynamically unstable patients may be considered. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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32. Suppression of amiodarone-induced torsade de pointes by landiolol in a patient with atrial fibrillation-mediated cardiomyopathy.
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Koji Takahashi, Mina Yamashita, Tomoki Sakaue, Daijiro Enomoto, Shigeki Uemura, Takafumi Okura, Shuntaro Ikeda, Masafumi Takemoto, Yutaka Utsunomiya, and Takashi Hyodo
- Abstract
An elderly Japanese woman developed acute decompensated heart failure caused by persistent atrial fibrillation (AF) and left ventricular systolic dysfunction. Approximately 6 days after starting intravenous administration of amiodarone (600 mg/day) for maintaining sinus rhythm after cardioversion of AF, electrocardiograms revealed a prolonged QT interval associated with torsade de pointes (TdP). The amiodarone-induced TdP disappeared after intravenous administration of landiolol plus magnesium and potassium, without discontinuation of amiodarone or overdrive cardiac pacing, although the prolonged QT interval persisted. To the best of our knowledge, this is the first report that landiolol could be effective for amiodarone-induced TdP. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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33. Suppression of cardiac memory–related severe form of torsades de pointes by landiolol in a patient with congenital long QT syndrome type 2
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Sou Otsuki, MD, PhD, Daisuke Izumi, MD, PhD, Yuki Hasegawa, MD, PhD, Nobue Yagihara, MD, PhD, Kenichi Iijima, MD, PhD, and Tohru Minamino, MD, PhD
- Subjects
Cardiac memory ,Long QT syndrome ,Landiolol ,Torsades de pointes ,Ventricular pacing ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2020
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34. Evaluating the Therapeutic Efficacy and Safety of Landiolol Hydrochloride for Management of Arrhythmia in Critical Settings: Review of the Literature
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Matsuishi Y, Mathis BJ, Shimojo N, Kawano S, and Inoue Y
- Subjects
landiolol ,β- blocker ,management of arrhythmia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Yujiro Matsuishi,1 Bryan J Mathis,2 Nobutake Shimojo,1 Satoru Kawano,1 Yoshiaki Inoue1 1Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; 2Medical English Communication Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JapanCorrespondence: Yujiro MatsuishiDepartment of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, JapanTel +81-29-853-5633Fax +81-29-853-3092Email matsuishi.yujiro.xa@alumni.tsukuba.ac.jpBackground: Landiolol hydrochloride, a highly cardio-selective beta-1 blocker with an ultra-short-acting half-life of 4 minutes, was originally approved by Japan for treatment of intraoperative tachyarrhythmias. This review aims to provide an integrated overview of the current state of knowledge of landiolol hydrochloride in the management of arrhythmia in critical settings.Methods: We searched MEDLINE, EMBASE, and the Cochrane Library to retrieve relevant articles with a total of 65 records identified.Results: The high β 1 selectivity (β 1/β 2 ratio of 255:1) of landiolol causes a more rapid heart rate (HR) decrease compared to esmolol while avoiding decreases in mean arterial blood pressure. Recently, it has been found useful in left ventricular dysfunction patients and fatal arrhythmia requiring emergency treatment. Recent random clinical trials (RCT) have revealed therapeutic and prophylactic effects on arrhythmia, and very low-dose landiolol might be effective for preventing postoperative atrial fibrillation (POAF) and sinus tachycardia. Likewise, landiolol is an optimal choice for perioperative tachycardia treatment during cardiac surgery. The high β 1 selectivity of landiolol is useful in heart failure patients as a first-line therapy for tachycardia and arrhythmia as it avoids the typical depression of cardiac function seen in other β-blockers. Application in cardiac injury after percutaneous coronary intervention (PCI), protection for vital organs (lung, kidney, etc.) during sepsis, and stabilizing hemodynamics in pediatric patients are becoming the new frontier of landiolol use.Conclusion: Landiolol is useful as a first-line therapy for the prevention of POAF after cardiac/non-cardiac surgery, fatal arrhythmias in heart failure patients and during PCI. Moreover, the potential therapeutic effect of landiolol for sepsis in pediatric patients is currently being explored. As positive RCT results continue to be published, new clinical uses and further clinical studies in various settings by cardiologists, intensivists and pediatric cardiologists are being conducted.Keywords: landiolol, β-blocker, management of arrhythmia
- Published
- 2020
35. Landiolol, an ultra-short acting beta-1 blocker, for preventing postoperative lung cancer recurrence: study protocol for a phase III, multicenter randomized trial with two parallel groups of patients
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Haruko Yamamoto, Toshimitsu Hamasaki, Kaori Onda, Takashi Nojiri, Masato Aragaki, Nao Horie, Norihiro Sato, and Yasuhiro Hida
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Beta-blocker ,Cancer recurrence ,Clinical trial ,Lung cancer ,Landiolol ,Medicine (General) ,R5-920 - Abstract
Abstract Background Recurrence of cancer after curative surgery is a major problem after most cancer treatments. Increased sympathetic activity during the perioperative period could promote cancer cell invasion to blood vessels and angiogenesis, resulting in cancer metastasis. Recent studies showed that use of beta blockers can be associated with the prolonged survival of patients with cancer. The objective of this study is to evaluate the preventive effects of landiolol hydrochloride, which is an ultra-short-acting beta-1-selective blocker that has been developed in Japan, on reducing recurrence of cancer after curative surgery for patients with lung cancer. Methods The present study is a phase III, multicenter, randomized trial with two parallel groups of patients with lung cancer, comparing surgery alone and surgery with landiolol administration for three days during the perioperative period. A total of 400 patients will be enrolled from 12 Japanese institutions. The primary endpoint is two-year relapse-free survival and overall survival after curative surgery for lung cancer. The secondary endpoints are additional treatment after recurrence of cancer, safety events, and the incidence of postoperative complications. Discussion The principal question addressed in this trial is whether landiolol can reduce recurrence of cancer after curative surgery for lung cancer. Trial registration Japan Registry of Clinical Trials, jRCT2011180004. Registered 17 January 2019.
- Published
- 2019
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36. Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Sepsis With Persistent Tachycardia Despite Initial Resuscitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
- Author
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Hasegawa, Daisuke, Sato, Ryota, Prasitlumkum, Narut, Nishida, Kazuki, Takahashi, Kunihiko, Yatabe, Tomoaki, and Nishida, Osamu
- Subjects
- *
RANDOMIZED controlled trials , *SEPSIS , *TACHYCARDIA , *SEPTIC shock , *RANDOM effects model , *TACHYCARDIA treatment , *RESEARCH , *CLINICAL trials , *META-analysis , *RESEARCH methodology , *SYSTEMATIC reviews , *MEDICAL cooperation , *EVALUATION research , *ADRENERGIC beta blockers , *COMPARATIVE studies , *RESUSCITATION , *PHARMACODYNAMICS , *DISEASE complications - Abstract
Background: Historically, β-blockers have been considered to be relatively contraindicated for septic shock because they may cause cardiac suppression. On the other hand, there is an increasing interest in the use of β-blockers for treating patients with sepsis with persistent tachycardia despite initial resuscitation.Research Question: Do ultrashort-acting β-blockers such as esmolol and landiolol improve mortality in patients with sepsis with persistent tachycardia despite initial resuscitation?Study Design and Methods: This was a systematic review and meta-analysis. We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) that compared the mortality of patients with sepsis and septic shock treated with esmolol or landiolol. We updated our search on April 20, 2020. Two independent reviewers assessed whether titles and abstracts met the following eligibility criteria: (1) RCT, (2) patients with sepsis and septic shock ≥ 18 years of age, and (3) treatment with either esmolol/landiolol or placebo/no interventions. Two authors independently extracted selected patient and study characteristics and outcomes. The results of all analyses are presented using random effect models.Results: Seven RCTs with a pooled sample size of 613 patients were included. Of these, six RCTs with 572 patients reported 28-day mortality. Esmolol or landiolol use in patients with sepsis and septic shock was significantly associated with lower 28-day mortality (risk ratio, 0.68; 95% CI, 0.54-0.85; P < .001). Unimportant heterogeneity was observed (I2 = 31%). The absolute risk reduction and number of patients to be treated to prevent one death were 18.2% and 5.5, respectively.Interpretation: The use of ultrashort-acting β-blockers such as esmolol and landiolol in patients with sepsis with persistent tachycardia despite initial resuscitation was associated with significantly lower 28-day mortality.Trial Registry: UMIN Clinical Trials Registry; No.: UMIN000040174; URL: https://www.umin.ac.jp/ctr/index.htm. [ABSTRACT FROM AUTHOR]- Published
- 2021
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37. β1-blocker in sepsis.
- Author
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Hasegawa, Daisuke, Sato, Ryota, and Nishida, Osamu
- Subjects
- *
HEART beat , *SEPSIS , *SEPTIC shock , *TACHYCARDIA , *RANDOMIZED controlled trials - Abstract
Background: The use of ultrashort-acting β1-blockers recently has attracted attention in septic patients with non-compensatory tachycardia. We summarized the metabolic and hemodynamic effects and the clinical evidence of ultrashort-acting β1-blockers. Main body: A recent meta-analysis showed that ultrashort-acting β1-blockers reduced the mortality in septic patients with persistent tachycardia. However, its mechanism to improve mortality is not fully understood yet. We often use lactate as a marker of oxygen delivery, but an impaired oxygen use rather than reduced oxygen delivery has been recently proposed as a more reasonable explanation of hyperlactatemia in patients with sepsis, leading to a question of whether β1-blockers affect metabolic systems. While the stimulation of the β2-receptor accelerates glycolysis and lactate production, the role of β1-blocker in lactate production remains unclear and studies investigating the role of β1-blockers in lactate kinetics are warranted. A meta-analysis also reported that ultrashort-acting β1-blockers increased stroke volume index, while it reduced heart rate, resulting in unchanged cardiac index, mean arterial pressure, and norepinephrine requirement at 24 h, leading to an improvement of cardiovascular efficiency. On the other hand, a recent study reported that heart rate reduction using fast esmolol titration in the very early phase of septic shock caused hemodynamic instability, suggesting that ultrashort-acting β1-blockers should be started only after completing initial resuscitation. While many clinicians still do not feel comfortable controlling sinus tachycardia, one randomized controlled trial in which the majority had sinus tachycardia suggested the mortality benefit of ultrashort-acting β1-blockers. Therefore, it still deems to be reasonable to control sinus tachycardia with ultrashort-acting β1-blockers after completing initial resuscitation. Conclusion: Accumulating evidence is supporting the use of ultrashort-acting β1-blockers while larger randomized controlled trials to clarify the effect of ultrashort-acting β1-blockers are still warranted. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
38. Landiolol in patients with septic shock resident in an intensive care unit (LANDI-SEP): study protocol for a randomized controlled trial
- Author
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Martin Unger, Andrea Morelli, Mervyn Singer, Peter Radermacher, Sebastian Rehberg, Helmut Trimmel, Michael Joannidis, Gottfried Heinz, Vladimír Cerny, Pavel Dostál, Christian Siebers, Fabio Guarracino, Francesca Pratesi, Gianni Biancofiore, Massimo Girardis, Pavla Kadlecova, Olivier Bouvet, Michael Zörer, Barbara Grohmann-Izay, Kurt Krejcy, Christoph Klade, and Günther Krumpl
- Subjects
Septic shock ,Sepsis ,Beta-blocker ,Landiolol ,Tachycardia ,Randomized controlled trial ,Medicine (General) ,R5-920 - Abstract
Abstract Background In patients with septic shock, the presence of an elevated heart rate (HR) after fluid resuscitation marks a subgroup of patients with a particularly poor prognosis. Several studies have shown that HR control in this population is safe and can potentially improve outcomes. However, all were conducted in a single-center setting. The aim of this multicenter study is to demonstrate that administration of the highly beta1-selective and ultrashort-acting beta blocker landiolol in patients with septic shock and persistent tachycardia (HR ≥ 95 beats per minute [bpm]) is effective in reducing and maintaining HR without increasing vasopressor requirements. Methods A phase IV, multicenter, prospective, randomized, open-label, controlled study is being conducted. The study will enroll a total of 200 patients with septic shock as defined by The Third International Consensus Definitions for Sepsis and Septic Shock criteria and tachycardia (HR ≥ 95 bpm) despite a hemodynamic optimization period of 24–36 h. Patients are randomized (1:1) to receive either standard treatment (according to the Surviving Sepsis Campaign Guidelines 2016) and continuous landiolol infusion to reach a target HR of 80–94 bpm or standard treatment alone. The primary endpoint is HR response (HR 80–94 bpm), the maintenance thereof, and the absence of increased vasopressor requirements during the first 24 h after initiating treatment. Discussion Despite recent studies, the role of beta blockers in the treatment of patients with septic shock remains unclear. This study will investigate whether HR control using landiolol is safe, feasible, and effective, and further enhance the understanding of beta blockade in patients with septic shock. Trial registration EU Clinical Trials Register; EudraCT, 2017-002138-22. Registered on 8 August 2017.
- Published
- 2018
- Full Text
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39. Long-term PK and Safety/Tolerability Testing LDLL600 Against Esmolol in Healthy Volunteers
- Published
- 2015
40. Randomized controlled trial of landiolol, a short-acting beta-1 adrenergic receptor blocker, illustrating changes in high-molecular weight adiponectin levels after elective percutaneous coronary intervention.
- Author
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Kiyokuni, Masayoshi, Konishi, Masaaki, Saigusa, Yusuke, Iwata, Kiwamu, Nakayama, Naoki, Komura, Naohiro, Sugano, Teruyasu, Ishigami, Tomoaki, Ishikawa, Toshiyuki, Yamanaka, Takeharu, Tamura, Kouichi, and Kimura, Kazuo
- Subjects
- *
PERCUTANEOUS coronary intervention , *ADRENERGIC receptors , *RANDOMIZED controlled trials , *MYOCARDIAL reperfusion , *MULTIPLE regression analysis , *ANGINA pectoris - Abstract
Adiponectin (APN) has cardioprotective properties and bisoprolol has been reported to increase myocardial APN expression and reduce myocardial damage. Administration of landiolol, which has a higher cardio-selectivity and shorter half-life than bisoprolol, during the percutaneous coronary intervention (PCI) may increase serum APN and high-molecular weight (HMW)-APN, an active form of APN, in patients with stable angina pectoris (SAP). We recruited 70 patients with SAP and randomized them to intravenous landiolol during PCI (N = 35) or control group (N = 35). The primary endpoint was serum APN and HMW-APN level 3 days after PCI. There was no difference in the primary endpoint between the landiolol and control groups (8.93 ± 5.24 vs. 10.18 ± 5.81 μg/mL, p = 0.35 and 3.36 ± 2.75 vs. 4.28 ± 3.13 μg/mL, p = 0.20) for APN and HMW-APN levels, respectively. APN and HMW-APN level were significantly decreased 1 day after PCI [−0.55 ± 0.92 μg/mL (9.87–9.32 μg/mL), p < 0.001 and −0.20 ± 0.45 μg/mL (3.89–3.69 μg/mL), p < 0.001, respectively]. Additionally, the absolute change in HMW-APN was significantly smaller in the landiolol group compared to the control group (−0.08 ± 0.27 vs. −0.31 ± 0.55 μg/mL, p = 0.031). Multiple linear regression analysis showed that use of landiolol was an independent predictor of change in HMW-APN (β = 0.276, p = 0.014). Serum APN and HMW-APN level 3 days after PCI were similar between patients treated with and without landiolol. APN and HMW-APN decreased 1 day after PCI in the SAP and landiolol mitigated decrease in HMW-APN. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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41. Efficacy and safety of cardioversion with continuous landiolol infusion for atrial tachyarrhythmia in an inflammatory state caused by volvulus in a child with TARP syndrome and postoperative tetralogy of Fallot
- Author
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Kenji Miyamoto, Junpei Ishii, Hironobu Fukuda, Shinichiro Ariga, Hiroshi Suzumura, Hidemitsu Kurosawa, Toru Kamijima, Takeshi Yamaguchi, Megumi Ogino, Takashi Tsuchioka, and Shigemi Yoshihara
- Subjects
β‐blocker ,atrial tachyarrhythmia ,Landiolol ,laparotomy ,TARP ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract A 2‐year‐old boy was diagnosed with TARP syndrome and underwent surgery for tetralogy of Fallot. He developed fever and had an acute abdomen. After 12 hours, atrial tachyarrhythmia (300 beats/min [bpm]) occurred. After nine administration of adenosine and two cardioversions, it relapsed promptly. Landiolol (10 μg/kg/min) was administered until the heart rate decreased to 270 bpm, and cardioversion was performed until sinus rhythm was normal. Exploratory laparotomy revealed small bowel volvulus. Systemic inflammation causing an acute abdomen may be associated with atrial tachyarrhythmia in postoperative tetralogy of Fallot. We speculated that landiolol lowered the defibrillation threshold of the atrium.
- Published
- 2018
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42. Effect of lidocaine with adrenaline and landiolol on hemodynamics in spontaneously hypertensive rats.
- Author
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Toru Oshikiri, Asami Iguchi, Katsuhisa Sunada, Kazuyuki Fujii, Kimito Sano, Oshikiri, Toru, Iguchi, Asami, Sunada, Katsuhisa, Fujii, Kazuyuki, and Sano, Kimito
- Subjects
LIDOCAINE ,UREA ,ADRENALINE ,HETEROCYCLIC compounds ,RATS ,ANIMALS - Abstract
Administration of local anesthetics with adrenaline can cause tachycardia and hypertension. This study assessed whether combined administration of landiolol with adrenaline and lidocaine would induce local anesthesia without causing hemodynamic changes. Normal saline (NS), lidocaine with adrenaline (LA), and lidocaine with adrenaline and landiolol (LLA) were injected into Wistar Kyoto (WKY/Izm) or spontaneously hypertensive (SHR/Izm) rats, followed by measurement of the pulse rate (PR), and the systolic, diastolic and mean blood pressures (SBP, DBP and MBP). In the LLA group, the increase in PR was significantly suppressed in both SHR/Izm and WKY/Izm rats relative to those in the LA group. Although SBP was significantly reduced in WKY/Izm rats given LLA, relative to those given NS or LA, it was elevated in SHR/Izm rats given LLA. Landiolol-induced changes in PR may be due to blockade of adrenaline-induced β1 receptor stimulation, which suppresses cardiac hyperactivity, whereas the early surge of blood pressure in SHR/Izm rats given LLA may be due to the dominant alpha-adrenergic effects of β1 receptor inhibition. The anti-adrenergic effects of LLA were safe and effective in WKY/Izm rats, although the unexpected early hypertensive surge in SHR/Izm rats indicates the need for caution. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
43. Recurrent takotsubo syndrome with worsening of left ventricular outflow obstruction during haemodialysis: a case report.
- Author
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Takada, Takuma, Jujo, Kentaro, Ishida, Issei, and Hagiwara, Nobuhisa
- Subjects
TAKOTSUBO cardiomyopathy ,VENTRICULAR outflow obstruction ,HEMODIALYSIS - Abstract
Background The recurrence rate of takotsubo syndrome (TS) has been reported as 1.8% per patient-year while left ventricular outflow tract (LVOT) obstruction is comorbid in 10–25% of all instances of TS. The clinical course of recurrent TS with associated LVOT while on haemodialysis has rarely been reported. Case summary This case report involves a 60-year-old female patient receiving regular haemodialysis who was admitted for chest pain during ballroom dancing. Four years prior, she had suffered TS, and fully recovered after the hospitalization. An emergent coronary angiogram done during the second hospitalization showed no significant stenosis, and left ventriculography demonstrated mid-apical akinesia and basal hyperkinesia. Based on these findings, we diagnosed the recurrence of TS. Later in the admission, chest pain reappeared with the start of haemodialysis. A transthoracic echocardiogram demonstrated mean pressure gradient (PG) of LVOT was 58 mmHg, with systolic anterior motion of the mitral valve and basal-wall hyperkinesia. The main aetiology for her symptoms was considered as an exacerbation of LVOT obstruction due to removing intravascular volume by haemodialysis. After starting landiolol at 3 μg/kg/min, PG of LVOT and symptoms gradually improved with uptitration of landiolol. Finally, her chest pain resolved when mean PG of LVOT was down to 38 mmHg using 10 μg/kg/min of landiolol. Discussion To our knowledge, this is the first report of a recurrent TS case comorbid with LVOT obstruction while on regular haemodialysis. Landiolol, the ultrashort-acting beta-blocker, may be a promising therapeutic option for rapid recovery of increased PG due to LVOT obstruction. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
44. Cost-Effectiveness Analysis of Landiolol, an Ultrashort-Acting Beta-Blocker, for Prevention of Postoperative Atrial Fibrillation for the Germany Health Care System.
- Author
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Walter, Evelyn and Heringlake, Matthias
- Abstract
Landiolol is an ultrashort-acting beta-blocker with high beta-1 receptor affinity and less blood pressure–lowering properties than other beta-blockers available for intravenous use in Germany. The present analysis aimed to determine whether perioperative treatment with landiolol in cardiac surgical patients is cost-effective under the conditions of the German Diagnosis-Related Groups health cost reimbursement system. On the basis of clinical outcome data from a meta-analysis that included 622 patients from 7 randomized controlled trials, a decision-model was developed to determine the cost-effectiveness of landiolol versus standard-of-care (SoC). Hospital setting. Hospital patients undergoing a representative mix of cardiac surgical procedures (MIX-CS) and isolated coronary artery bypass grafting (CABG). Landiolol versus SoC in prevention of atrial fibrillation immediately after cardiac surgery. The model benefit was expressed in a reduction of postoperative atrial fibrillation (POAF) episodes and reduced complications. The model calculated total inpatient costs over the hospital length of stay. Costs from published sources were used for the German hospital perspective. SoC was associated with POAF rates of 36.0% to 39.2% and 24.4% to 30.1% in the MIX-CS and CABG populations, respectively. Patients with POAF had a higher morbidity and mortality. Estimated total costs for SoC patients in the MIX-CS and CABG groups were 28.792 € and 25.630 €, respectively. Landiolol reduced the incidence of POAF to 12.6% in the MIX-CS and 12.1% in the CABG groups. This was associated with a cost reduction of 2.209 € and 1.470 €. This analysis suggests that preventing POAF with landiolol is highly cost-effective. Additional studies are needed to assess whether a comparable reduction in POAF and associated cost savings may be achieved using conventional intravenous beta-blockers or amiodarone. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
45. Landiolol suppression of electrical storm of torsades de pointes in patients with congenital long-QT syndrome type 2 and myocardial ischemia
- Author
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Ryota Kitajima, MD, Takeshi Aiba, MD, Tsukasa Kamakura, MD, Kohei Ishibashi, MD, Mitsuru Wada, MD, Yuko Inoue, MD, Koji Miyamoto, MD, Hideo Okamura, MD, Takashi Noda, MD, Satoshi Nagase, MD, Yu Kataoka, MD, Yasuhide Asaumi, MD, Teruo Noguchi, MD, Satoshi Yasuda, MD, and Kengo Kusano, MD
- Subjects
Torsade de pointes ,Long-QT syndrome ,β-blocker ,Landiolol ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 76-year-old man who had been diagnosed with long-QT syndrome type 2 had frequent syncopal attacks. The electrocardiogram was monitored, and frequent torsades de pointes (TdP) was detected despite administration of conventional medications: oral propranolol, verapamil, intravenous magnesium sulfate, verapamil, and lidocaine. In contrast, 2 μg/kg/min landiolol could completely suppress TdP. Subsequently, an implantable cardioverter defibrillator was placed, and he was diagnosed with silent myocardial ischemia using myocardial perfusion scintigraphy and coronary angiography. This is the first case report wherein landiolol effectively suppressed TdP due to long-QT syndrome with silent myocardial ischemia.
- Published
- 2017
- Full Text
- View/download PDF
46. Landiolol, an ultra-short acting beta-1 blocker, for preventing postoperative lung cancer recurrence: study protocol for a phase III, multicenter randomized trial with two parallel groups of patients.
- Author
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Yamamoto, Haruko, Hamasaki, Toshimitsu, Onda, Kaori, Nojiri, Takashi, Aragaki, Masato, Horie, Nao, Sato, Norihiro, and Hida, Yasuhiro
- Subjects
- *
CANCER relapse , *LUNG cancer , *CLINICAL trial registries , *LUNG surgery , *METASTASIS , *POSTOPERATIVE pain , *NATALIZUMAB - Abstract
Background: Recurrence of cancer after curative surgery is a major problem after most cancer treatments. Increased sympathetic activity during the perioperative period could promote cancer cell invasion to blood vessels and angiogenesis, resulting in cancer metastasis. Recent studies showed that use of beta blockers can be associated with the prolonged survival of patients with cancer. The objective of this study is to evaluate the preventive effects of landiolol hydrochloride, which is an ultra-short-acting beta-1-selective blocker that has been developed in Japan, on reducing recurrence of cancer after curative surgery for patients with lung cancer.Methods: The present study is a phase III, multicenter, randomized trial with two parallel groups of patients with lung cancer, comparing surgery alone and surgery with landiolol administration for three days during the perioperative period. A total of 400 patients will be enrolled from 12 Japanese institutions. The primary endpoint is two-year relapse-free survival and overall survival after curative surgery for lung cancer. The secondary endpoints are additional treatment after recurrence of cancer, safety events, and the incidence of postoperative complications.Discussion: The principal question addressed in this trial is whether landiolol can reduce recurrence of cancer after curative surgery for lung cancer.Trial Registration: Japan Registry of Clinical Trials, jRCT2011180004. Registered 17 January 2019. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
47. A prospective observational survey on landiolol in atrial fibrillation/atrial flutter patients with chronic heart failure – AF-CHF landiolol survey.
- Author
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Yamashita, Takeshi, Nakasu, Yukiko, Mizutani, Hiroto, and Sumitani, Kenji
- Abstract
• Ultrashort-acting β-blockers, including landiolol, can rapidly control heart rate. • Landiolol safety/effectiveness was assessed in atrial fibrillation/atrial flutter patients with heart failure in routine practice. • The safety of landiolol was acceptable without new safety concerns. • Most patients achieved effective heart rate control during their arrhythmias. Atrial fibrillation and atrial flutter occur commonly in patients with heart failure. Ultrashort-acting β-blockers, including landiolol, can rapidly control heart rate. As part of postmarketing surveillance for landiolol in Japan, a real-world drug-use survey (AF-CHF landiolol survey) was established for the treatment of atrial fibrillation and atrial flutter in patients with heart failure. We report the safety and effectiveness of landiolol from this survey, focusing on adverse events/adverse drug reactions. Consecutive patients with cardiac dysfunction who received landiolol (continuous intravenous infusion, starting at 1 μg/kg/min) for atrial fibrillation or atrial flutter in routine clinical practice in Japan were enrolled between June 2014 and May 2016. Safety variables included adverse events and adverse drug reactions (number of patients and events, incidence rate, types, seriousness). Effectiveness variables included the proportion of patients with a ≥20% decrease in heart rate. Data were available for 1121 patients (safety analysis set); 888 patients were evaluable for effectiveness parameters. Mean (± standard deviation) patient age was 72.5 ± 13.5 years, 57.2% were male. Most patients (84.2%) received landiolol for atrial fibrillation. Overall, 174 adverse events occurred in 140 patients (12.5%), including 105 serious adverse events. The most common type of adverse events was cardiac (60 events). Seventy-five events in 63 patients were categorized as adverse drug reactions (5.6% of patients). Mean heart rate decreased substantially after treatment with landiolol, by ≥20% in 77.5% of patients. In a real-world setting in Japan, landiolol for the treatment of atrial fibrillation or atrial flutter with heart failure was acceptable without new safety concerns, and most patients achieved effective heart rate control during their arrhythmias. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
48. Patient Management OPCAB
- Author
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Sadahiro, Mitsuaki, Asai, Tohru, editor, Ochi, Masami, editor, and Yokoyama, Hitoshi, editor
- Published
- 2016
- Full Text
- View/download PDF
49. Controlled Study of ONO-1101 in Patients With Postoperative Tachyarrhythmias in Japan
- Published
- 2012
50. Controlled Study of ONO-1101 in Patients With Postoperative Tachyarrhythmias in Japan
- Published
- 2012
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