Effects of landiolol hydrochloride on intractable tachyarrhythmia after pediatric cardiac surgery.

Background. While beta-blockers can be effective in controlling tachyarrhythmias after pediatric cardiac surgery, a negative inotropic influence sometimes complicates their use. Landiolol hydrochloride is a novel, ultra-short-acting beta-blocker recently developed in Japan. The drug has higher beta 1:beta 2 selectivity ratio and a less negative inotropic effect. This study retrospectively evaluates the efficacy and safety of landiolol in the management of tachyarrhythmias after pediatric cardiac surgery. Methods. A retrospective analysis was performed on 312 consecutive patients undergoing surgery for congenital heart disease. Twelve patients were treated with landiolol for critical tachyarrhythmia. The mean age of patients was 28.7 +/- 10.6 months. Five junctional ectopic tachycardia, 2 atrial flutters, 1 paroxysmal supraventricular tachycardia, 1 atrial fibrillation, 1 atrioventricular reciprocating tachycardia with Wolff-Parkinson-White syndrome and 2 excessive sinus tachycardia were treated. Results. The mean loading and maintenance doses were 11.3 +/- 4.0 and 6.8 +/- 0.9 mu g/kg per minute, respectively. Rate control was achieved in all patients. Landiolol reduced the heart rate from 169.7 +/- 11.4 to 127.7 +/- 7.5 beats per minute (p < 0.05) while blood pressure did not significantly change. Tachyarrhythmias were converted to sinus rhythm in 70.0% of the cases and the average time needed to achieve heart rate reduction was 2.3 +/- 0.5 hours. Conclusions. Landiolol was efficacious in treating tachyarrhythmia in pediatric cardiac surgery. The desired negative chronotropic effect was achieved without significant hemodynamic compromise. The ultra-short halflife of landiolol provided rapid dose manipulation. This study suggests that landiolol is a promising option for the management of postoperative tachyarrhythmias in pediatric patients. (C) 2013 by The Society of Thoracic Surgeons