Urgent Management of Rapid Heart Rate in Patients With Atrial Fibrillation/Flutter and Left Ventricular Dysfunction - Comparison of the Ultra-Short-Acting β1-Selective Blocker Landiolol With Digoxin (J-Land Study)

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.. Methods and Results: The 200 patients with AF/AFL, HR >= 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 >= 20% reduction in HR together with HR <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'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<0.0001). Serious adverse events were reported in 2 and 3 patients in each group, respectively. 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)