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) –

Ryozo Nagai; Koichiro Kinugawa; Hiroshi Inoue; Hirotsugu Atarashi; Yoshihiko Seino; Takeshi Yamashita; Wataru Shimizu; Takeshi Aiba; Masafumi Kitakaze; Atsuhiro Sakamoto; Takanori Ikeda; Yasushi Imai; Takashi Daimon; Katsuhiro Fujino; Tetsuji Nagano; Tatsuaki Okamura; Masatsugu Hori; the J-Land Investigators

doi:10.1253/circj.CJ-12-1618

Late Breaking Clinical Trials (JCS 2013)

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) –

Ryozo Nagai, Koichiro Kinugawa, Hiroshi Inoue, Hirotsugu Atarashi, Yoshihiko Seino, Takeshi Yamashita, Wataru Shimizu, Takeshi Aiba, Masafumi Kitakaze, Atsuhiro Sakamoto, Takanori Ikeda, Yasushi Imai, Takashi Daimon, Katsuhiro Fujino, Tetsuji Nagano, Tatsuaki Okamura, Masatsugu Hori, the J-Land Investigators

Author information

Ryozo Nagai
Jichi Medical University
Koichiro Kinugawa
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Hiroshi Inoue
The Second Department of Internal Medicine, University of Toyama, Graduate School of Medicine
Hirotsugu Atarashi
Department of Internal Medicine, Nippon Medical School Tama-Nagayama Hospital
Yoshihiko Seino
Department of Cardiology, Nippon Medical School Chiba-Hokusoh Hospital
Takeshi Yamashita
The Cardiovascular Institute
Wataru Shimizu
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
Takeshi Aiba
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
Masafumi Kitakaze
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
Atsuhiro Sakamoto
Department of Anesthesiology, Nippon Medical School
Takanori Ikeda
Department of Cardiovascular Medicine, Toho University Faculty of Medicine
Yasushi Imai
Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
Takashi Daimon
Department of Biostatistics, Hyogo College of Medicine
Katsuhiro Fujino
Ono Pharmaceutical Co Ltd
Tetsuji Nagano
Ono Pharmaceutical Co Ltd
Tatsuaki Okamura
Ono Pharmaceutical Co Ltd
Masatsugu Hori
Osaka Medical Center for Cancer and Cardiovascular Diseases
the J-Land Investigators

Keywords: Atrial fibrillation, Atrial flutter, β-blocker, Landiolol, Left ventricular dysfunction

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Supplementary material

2013 Volume 77 Issue 4 Pages 908-916

DOI https://doi.org/10.1253/circj.CJ-12-1618

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Abstract

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 β-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 ≥120beats/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 <110beats/min at 2h after starting intravenous administration of landiolol or digoxin. The dose of landiolol was adjusted in the range of 1–10μg·kg^–1·min^–1 according to the patient’s condition. The mean HR at baseline was 138.2±15.7 and 138.0±15.0beats/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)

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