Urgent Management of Rapid Heart Rate in Patients With Atrial Fibrillation/Flutter and Left Ventricular Dysfunction - Comparison of the Ultra-Short-Acting beta 1-Selective Blocker Landiolol With Digoxin (J-Land Study)

作者：Nagai Ryozo; Kinugawa Koichiro; Inoue Hiroshi; Atarashi Hirotsugu; Seino Yoshihiko; Yamashita Takeshi; Shimizu Wataru; Aiba Takeshi; Kitakaze Masafumi; Sakamoto Atsuhiro; Ikeda Takanori; Imai Yasushi; Daimon Takashi; Fujino Katsuhiro; Nagano Tetsuji; Okamura Tatsuaki; Hori Masatsugu^*

来源：Circulation Journal, 2013, 77(4): 908-916.

DOI：10.1253/circj.CJ-12-1618

• Atrial fibrillation
• Atrial flutter
• beta-blocker
• Landiolol
• Left ventricular dysfunction

Background: A rapid heart rate (HR) during atrial fibrillation (AF) and atrial flutter (AFL) in left ventricular (LV) dysfunction often impairs cardiac performance. The J-Land study was conducted to compare the efficacy and safety of landiolol, an ultra-short-acting p-blocker, with those of digoxin for swift control of tachycardia in AF/AFL in patients with LV dysfunction.. %26lt;br%26gt;Methods and Results: The 200 patients with AF/AFL, HR %26gt;= 120 beats/min, and LV ejection fraction 25-50% were randomized to receive either landiolol (n=93) or digoxin (n=107). Successful HR control was defined as %26gt;= 20% reduction in HR together with HR %26lt;110 beats/min at 2h after starting intravenous administration of landiolol or digoxin. The dose of landiolol was adjusted in the range of 1-10 mu g.kg(-1).min(-1) according to the patient%26apos;s condition. The mean HR at baseline was 138.2 +/- 15.7 and 138.0 +/- 15.0 beats/min in the landiolol and digoxin groups, respectively. Successful HR control was achieved in 48.0% of patients treated with landiolol and in 13.9% of patients treated with digoxin (P%26lt;0.0001). Serious adverse events were reported in 2 and 3 patients in each group, respectively. %26lt;br%26gt;Conclusions: Landiolol was more effective for controlling rapid HR than digoxin in AF/AFL patients with LV dysfunction, and could be considered as a therapeutic option in this clinical setting. (Circ J 2013; 77: 908-916)

• 出版日期2013-4