Efficacy and safety of landiolol in patients with refractory ventricular arrhythmia and electrical storm: a single-center experience
B Zawislak, M Wegiel, M Bagienski, S Arif, A Dziewierz, S Bartus, T RakowskiAbstract
Background
The management of refractory ventricular arrhythmia (VA) and electrical storm (ES) remains a significant clinical challenge, particularly in patients with reduced left ventricular ejection fraction (LVEF). Although landiolol is primarily used for the management of supraventricular arrhythmias, its efficacy in VAs remains poorly defined. Its potent anti-arrhythmic properties with minimal negative inotropic effects may offer a therapeutic advantage in this setting.
Purpose
To assess the clinical efficacy, safety profile, and hemodynamic tolerability of landiolol infusion in patients with recurrent VA or ES.
Methods
This retrospective, single-center analysis evaluated 31 consecutive patients presenting with recurrent VA or ES who were treated with landiolol.
Results
The cohort (80.6% male; age 62.3 +/- 16.3 years) was characterized by significant cardiovascular complexity, including a high prevalence of heart failure (71.0%), a history of myocardial infarction (58.1%), and a median LVEF of 20%. Landiolol was administered at a median starting dose of 1 µg/kg/min, with a mean maximal dose of 3.8±2.5 µg/kg/min over a median infusion duration of 5 days. Rapid anti-arrhythmic efficacy was observed, with 74.2% of patients achieving freedom from ventricular tachycardia (VT) within the first hour of infusion. This response was sustained, as 67.7% of patients remained VT-free and required no further electrotherapy at 24 hours. Despite the high-risk profile of the cohort, landiolol demonstrated a favorable safety profile. Treatment-emergent adverse effects were infrequent, with low rates of hypotension (12.9%) and bradycardia (3.2%). Notably, only two patients required up-titration of vasopressor support during the infusion period (Table).
Conclusions
Landiolol demonstrated significant clinical efficacy in suppressing refractory VAs while maintaining a favorable safety profile in a high-risk cohort, as evidenced by low rates of treatment-limiting hypotension and bradycardia. These findings suggest that landiolol may be safely integrated into multimodal anti-arrhythmic strategies; however, prospective randomized trials are warranted to validate these retrospective observations.Table