How effective is landiolol?

Landiolol is a highly selective, ultra-short-acting β1-blocker that has been approved in many countries and is mainly used to rapidly control tachyarrhythmias in perioperative and intensive care settings. Its unique pharmacological properties make it an effective choice for heart rate control in patients with supraventricular tachycardia (including atrial fibrillation and atrial flutter), and is particularly suitable for clinical scenarios requiring short-term, precise heart rate management.

A large number of randomized controlled clinical trials have confirmed the therapeutic efficacy of landiolol. In patients who develop intraoperative or postoperative supraventricular tachycardia, landiolol significantly reduces heart rate and reaches steady state within a short period of time compared with placebo. For patients with atrial fibrillation/atrial flutter and left ventricular dysfunction, landiolol has a better heart rate-lowering effect than digoxin and can stabilize the heart rhythm faster. In addition, landiolol is more effective than diltiazem in the management of postoperative atrial fibrillation (POAF), returning the heart rhythm to sinus rhythm more quickly, and its perioperative prophylactic use significantly reduces the risk of POAF in the first postoperative week.

In addition to its use in atrial fibrillation and atrial flutter, landiolol is also used to alleviate adverse hemodynamic reactions caused by invasive procedures. For example, during endotracheal intubation, extubation, percutaneous coronary intervention (PCI), and electroconvulsive therapy, patients may experience sympathetic overactivation, leading to increased heart rate and blood pressure fluctuations. The use of landiolol can effectively reduce these effects and help patients go through the perioperative period or treatment process more smoothly.

Landiolol is generally well tolerated, with relatively low incidences of hypotension and bradycardia, especially with appropriate dose adjustments. Compared with Esmolol, another short-acting β-blocker, landiolol has superior pharmacological properties, including higher β1 selectivity, shorter half-life, and smoother heart rate control effect. These features make it ideal for patients who require precise dosage adjustments, such as the elderly or those with compromised cardiac function.

Reference materials:https://pubmed.ncbi.nlm.nih.gov/29470800/