Landiolol for acute heart rate control in the cardiac intensive care unit: early experience from University Hospital Centre Zagreb

    Authors

    Keywords

    landiolol, cardiac intensive care unit, heart rate control

    DOI

    https://doi.org/10.15836/ccar2025.229

    Full Text

    **Introduction**: To report our center’s initial experience with intravenous (IV) landiolol for acute heart rate control in critically ill cardiac patients, focusing on hemodynamic stability and tissue perfusion markers. **Patients and Methods**: This retrospective study included all patients treated with IV landiolol in the Cardiac Intensive Care Unit (CICU) at the University Hospital Centre Zagreb between September 2024 and September 2025. Administrations separated by ≥24 hours were defined as distinct episodes. Baseline demographics and laboratory data were collected. During the first 24 h heart rate (HR), mean arterial pressure (MAP), vasoactive drugs, and urine output were recorded every 2 h when available. Categorical variables are presented as counts, and continuous variables as medians (minimum-maximum). Statistical significance was set at 2) received landiolol, yielding 14 episodes (11 supraventricular tachyarrhythmias, 3 ventricular tachycardia). Cardiogenic shock occurred in 11 episodes, sepsis in 8, septic shock in 4, and mechanical circulatory support was required in 4. Landiolol was started at 18.5 (1–92) days after CICU admission, with a duration of 37.5 (6.8–634.9) h and mean dose 5.1 ± 3.4 µg/kg/min. HR decreased significantly at 2 h (145 [85–190] vs. 105 [70–135] bpm; p = 0.003) and over 24 h (103 [75–130]; p = 0.002). MAP remained stable (73.5 [40–99] vs. 75.5 [55–87] at 2 h, p = 0.22; 75.3 [60–88] 24 h/average, p = 0.27). Lactates showed no change (1.4 [0.3–3.9] vs. peak 1.4 [0.3–7.2]; p = 0.11). Urine output before and after initiation was 2700 [0–4230] vs. 2100 [0–3310] mL/24 h, p = 0.07 (**Figure 1**). No patients required vasoactive support at initiation, but 5/14 episodes required it during therapy, all in sepsis or septic shock. FIGURE 1. Hemodynamic and perfusion dynamics following landiolol initiation in 14 treatment episodes. Bpm – beats per minute; AVG – average; MAP – mean arterial pressure **Conclusions**: In this initial single-centre experience since the national introduction of landiolol, the drug achieved rapid and sustained rate control in critically ill CICU patients, including those with cardiogenic shock and sepsis. HR reduction was not associated with MAP or lactate deterioration, while urine output before and after did not differ significantly. Landiolol may be a safe and effective option for rate control in the CICU, but larger studies are warranted. (1-3)

    Literature

    1. Manna ML, Tavecchia GA, Luongo A, Cesari A, Garatti L, Scavelli F, et al. Use of landiolol for acute heart rate management in critically ill cardiac patients: a retrospective single-center experience. Eur Heart J Acute Cardiovasc Care. 2025 Apr 1;14(Suppl_1):zuaf044.003. https://doi.org/10.1093/ehjacc/zuaf044.003
    2. Bezati S, Velliou M, Polyzogopoulou E, Boultadakis A, Parissis J. The role of landiolol in the management of atrial tachyarrhythmias in patients with acute heart failure and cardiogenic shock: case reports and review of literature. Eur Heart J Suppl. 2022 June 13;24 Suppl D:D22–33. https://doi.org/10.1093/eurheartjsupp/suac024
    3. Rehberg S, Frank S, Černý V, Cihlář R, Borgstedt R, Biancofiore G, et al. Landiolol for heart rate control in patients with septic shock and persistent tachycardia. A multicenter randomized clinical trial (Landi-SEP). Intensive Care Med. 2024 October;50(10):1622–34. https://doi.org/10.1007/s00134-024-07587-1
    Cardiologia Croatica
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    Landiolol for acute heart rate control in the cardiac intensive care unit: early experience from University Hospital Centre Zagreb

    Extended Abstract
    Issue9-10
    Published
    Pages229-230
    PDF via DOIhttps://doi.org/10.15836/ccar2025.229
    landiolol
    cardiac intensive care unit
    heart rate control

    Authors

    Mirna Momčilović*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vanja NedeljkovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dora MeštrovićORCIDZagreb Emergency Medicine Service, Zagreb, Croatia
    Marijan PašalićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedran PašaraORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ana MarinićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dora FabijanovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivo PlanincORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Nina JakušORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jure SamardžićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Daniel LovrićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: mirna.momcilovic@gmail.com

    Full Text

    Introduction: To report our center’s initial experience with intravenous (IV) landiolol for acute heart rate control in critically ill cardiac patients, focusing on hemodynamic stability and tissue perfusion markers.

    Patients and Methods: This retrospective study included all patients treated with IV landiolol in the Cardiac Intensive Care Unit (CICU) at the University Hospital Centre Zagreb between September 2024 and September 2025. Administrations separated by ≥24 hours were defined as distinct episodes. Baseline demographics and laboratory data were collected. During the first 24 h heart rate (HR), mean arterial pressure (MAP), vasoactive drugs, and urine output were recorded every 2 h when available. Categorical variables are presented as counts, and continuous variables as medians (minimum-maximum). Statistical significance was set at <0.05.

    Results: Ten patients (8 men; age 56 [31-81] years; BMI 25.4 [20.7-37.4] kg/m2) received landiolol, yielding 14 episodes (11 supraventricular tachyarrhythmias, 3 ventricular tachycardia). Cardiogenic shock occurred in 11 episodes, sepsis in 8, septic shock in 4, and mechanical circulatory support was required in 4. Landiolol was started at 18.5 (1–92) days after CICU admission, with a duration of 37.5 (6.8–634.9) h and mean dose 5.1 ± 3.4 µg/kg/min. HR decreased significantly at 2 h (145 [85–190] vs. 105 [70–135] bpm; p = 0.003) and over 24 h (103 [75–130]; p = 0.002). MAP remained stable (73.5 [40–99] vs. 75.5 [55–87] at 2 h, p = 0.22; 75.3 [60–88] 24 h/average, p = 0.27). Lactates showed no change (1.4 [0.3–3.9] vs. peak 1.4 [0.3–7.2]; p = 0.11). Urine output before and after initiation was 2700 [0–4230] vs. 2100 [0–3310] mL/24 h, p = 0.07 (Figure 1). No patients required vasoactive support at initiation, but 5/14 episodes required it during therapy, all in sepsis or septic shock.

    FIGURE 1. Hemodynamic and perfusion dynamics following landiolol initiation in 14 treatment episodes. Bpm – beats per minute; AVG – average; MAP – mean arterial pressure

    Conclusions: In this initial single-centre experience since the national introduction of landiolol, the drug achieved rapid and sustained rate control in critically ill CICU patients, including those with cardiogenic shock and sepsis. HR reduction was not associated with MAP or lactate deterioration, while urine output before and after did not differ significantly. Landiolol may be a safe and effective option for rate control in the CICU, but larger studies are warranted. (1–3)

    Literature

    1. 1.
      Manna ML, Tavecchia GA, Luongo A, Cesari A, Garatti L, Scavelli F, et al. Use of landiolol for acute heart rate management in critically ill cardiac patients: a retrospective single-center experience. Eur Heart J Acute Cardiovasc Care. 2025 Apr 1;14(Suppl_1):zuaf044.003.DOI
    2. 2.
      Bezati S, Velliou M, Polyzogopoulou E, Boultadakis A, Parissis J. The role of landiolol in the management of atrial tachyarrhythmias in patients with acute heart failure and cardiogenic shock: case reports and review of literature. Eur Heart J Suppl. 2022 June 13;24 Suppl D:D22–33.DOI
    3. 3.
      Rehberg S, Frank S, Černý V, Cihlář R, Borgstedt R, Biancofiore G, et al. Landiolol for heart rate control in patients with septic shock and persistent tachycardia. A multicenter randomized clinical trial (Landi-SEP). Intensive Care Med. 2024 October;50(10):1622–34.DOI